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Special Attention Is called to the tollowlno : 

The next Annual Meeting of the Medical Soci- 
ety OF New Jersey will be held at Deal Beach, on 
the 27th, 28th and 29th of June, 1899. 

Each District Society is entitled to three Dele- 
gates at large and one additional for every ten 
members. Permanent delegates will be elected at 
this session. 

The District Reporters are requested to send 
their reports to the Chairman of the Standing 
Committee at least three weeks before the time 
of the Annual Meeting. 

The Standing Committee would remind Report- 
ers that their reports are to be published in the 
volume of Transactions, and should therefore be 
carefully prepared, and that names and medical 
terms especially should be distinctly written. 
Reports from other physicians should be incorpor- 
ated in their own report. 

The assessment for the year 1898. upon District 
Societies, is two dollars for each member. 

The Secretaries of the respective Societies are 
requested to send a list of Annual Delegates and 
of Active Members in regular standing, with post- 
office addresses, to the Recording Secretary, Dr. 
William Chandler, South Orange, at least ten days 
before the Annual Meeting. 



FELLOWS' PRIZE ESSAY. 



This prize is open for competition to the members of 
the District Medical Societies. 

The Essays must be signed with an assumed name and 
have a motto, both of which shall be endorsed on a sealed 
envelope, to accompany the Essay, containing the author's 
name, residence and District Society. 

The Essays must be placed in the hands of the chair, 
man of the Committee, on or before the first day in 
May, 1899. 

The Committee will select the first two essays in order 
of merit. To the first will be awarded the prize of one 
hundred dollars; to the second, that of honorary mention. 

The unsuccessful authors will receive back their essays 
upon their identification to the chairman of the Commit- 
tee. The successful Essays will be the property of the 
Society, and be published in its Transactions. 

H. GENET TAYLOR, Chairman, Camden, 
CHARLES J. KIPP. Newark. 
P. A. HARRIS, Paterson. 

Coynmittee. 



TRANSACTIONS 



OF THE 



Medical Society 



OF 



NEW JERSEY 



1898 



A. J. Hardham, Printer, 243 6* 245 Market Street, Netoark, N. J. 

1898. 



OFFICERS, 1898. 

PR E SID UN T. 

C. R. P. FISHER, .... Bound Brook 

VICE-PRESIDENTS, 

LUTHER M. HALSEY, - - - Williamstown 

WILLIAM PIERSON, Orange 

J. D. McGlLL, Jersey City 

CORRESPONDING SECRETARY. 

E. L. B. GODFREY. Camden 

RECORDING SECRETARY. 

WILLIAM J. CHANDLER, - - - South Orange 

TREASURER. 

ARCHIBALD MERCER, .... Newark 

STANDING COMMITTEE. 

TERM EXPIRES Z899. 

HENRY W. ELMER, Bridgeion 

HENRY MITCHELL, . . - . Asbury Park 

TERM EXPIRES I900. 

WILLIAM D. ISZARD, Camden 

STEPHEN PIERSON, - - - Morristown 

TERM EXPIRES I9OI. 

DOWLING BENJAMIN, - ... Camden 
JOSEPH HEDGES, Branchville 



FELLOWS. 



AH pencHis who shall have been, or may hereafter be President of the Society, shall rank as 
Fellows, and be entitled to all the privileges of delegated members. 

Act o/ Incorp^rtUwHf Sec. i. 
The dates represent the year of official service as President 
Those marked thus (*) are deceased. 



♦Robert McKean 1766 *Charles Smith 

♦William Burnett 1767 ♦Matt. H. Williamson. . 

♦John Cochran 1 768 ♦Samuel Forman , 

♦Nathaniel Scudder 1770 ♦John Van Cleve 

♦Isaac Smith 1771 ♦Lewis Dunham 

♦James Newell 1772 ♦Peter I. Stryker 

♦Absalom BAINBRIDGE....1773 ♦John Van Cleve 

*Thomas Wiggins 1774 ♦Lewis Condict 

♦Hezekiah Stites 1775 *James Lee 

♦ ♦ ♦ ♦ ♦ ♦William G. Reynolds.. 

♦John Beatty 1782 ♦Augustus R. Taylor... 

♦Thomas Barber 1783 ♦William B. Ewing 

♦Lawrence Van DERVEER.1784 ♦Peter L Stryker 

♦Moses Bloomfield 1785 ♦Gilbert S. Woodhull.. 

♦William Burnett 1 786 ♦Wm. D. McKiss ack 

♦Jonathan Elmer 1787 ♦Isaac Pierson 

♦James Stratton 1788 ♦Jeptha B. Munn 

♦Moses Scott 1789 ♦John W. Craig 

♦John Griffith 1790 ♦Augustus R. Taylor. . . 

♦Lewis Dunham 1 791 ♦Thomas Yarrow 

♦Isaac Harris 1792 ♦Fitz Randolph Smith. . 

♦Elisha Newell 1795 ♦William Forman 

♦Jonathan F. Morris 1 807 ♦Samuel Hayes 

♦Peter I. Stryker 1808 ♦Abm. P. Hageman 

♦Lewis Morgan 1809 ♦Henry Van Derveer. . . 

♦Lewis Condict 1810 ♦Lyndon A. Smith 



811 
812 
814 

815 
816 

817 
818 

819 

820 

821 

822 

823 

824 

825 

826 

827 

828 

829 

830 

832 

833 
834 

835 
836 

837 



8 



MEDICAL SOCIETY OF NEW JERSEY. 



♦BENJ. H. STRATTON 1838 

♦Jabez G. Goble 1839 

♦Thomas P. Stewart 1840 

♦Ferdinand S. SCHENCK..1841 

♦Zachariah Read 1842 

♦Abraham Skillman 1843 

♦George R. Chetwood. . . 1844 

♦Robert S. Smith 1845 

♦Charles Hannah 1846 

♦Jacob T. B. Skillman 1847 

Samuel H. Pennington. 1848 

♦Joseph Fithian 1849 

♦Elias J. Marsh 1850 

♦John H. Phillips 1851 

♦Othn'l H. Taylor 1852 

♦Samuel Lilly 1853 

♦A. B. Dayton 1854 

♦J. B. Coleman... 1855 

♦Richard M. Cooper 1856 

♦Thomas Ryerson 1857 

♦Isaac P.Coleman 1858 

♦John R. Sickler 1859 

♦Wm. Elmer i860 

♦JNO. Blane 1861 

♦JNO. Woolverton 1862 

♦Theo. R. Varick 1863 

♦Ezra M. Hunt 1864 

♦Abram Coles 1865 

♦Benjamin R. Bateman.. . 1866 

jNo. C. Johnson 1867 



♦Thomas J. Corson 

♦William Pierson 

♦Thomas F. Cullen 

♦Charles Hasbrouck 

Franklin Gauntt 

♦T. J. Thomason 

♦G. H. Larison 

♦Wm. O'Gorman 

♦j no. v. schenck 

Henry R. Baldwin 

John S. Cook 

Alex. W. Rogers 

♦Alex. N. Dougherty 

♦Lewis W. Oakley 

♦John W. Snowden 

♦Stephen Wickes 

P. C. Barker 

♦Joseph Parrish 

Charles J. Kipp 

John W. Ward 

H. Genet Taylor 

♦B. A. Watson 

♦Jas.S. Green 

Elias J. Marsh 

George T. Welch 

John G. Ryerson 

O. H. Sproul 

William Elmer.. 

T. J. Smith 

David C. English 



868 
869 
870 

871 
872 

873 
874 

875 
876 

877 
878 

879 

880 

881 

882 

883 

884 
885 
886 

887 
888 
889 
890 
891 
892 
983 
894 

895 
896 

897 



HONORARY MEMBERS. 



*David Hosack. New York 1827 

*J. W. Francis 1827 

♦John Condict, Orange 1830 

*USHER Parsons. Rhode Island 1839 

♦Reuben D. Murphy, Cincinnati 1839 

♦Alban G. Smith. New York 1839 

♦WiLLARD Parker, New York^ 1842 

♦Valentine Mott, New York 1843 

♦Jonathan Knight, New Haven 1848 

♦Nathaniel Chapman, Philadelphia 1848 

♦Alexander H. Stephens, New York 1848 

♦John C. Warren, Boston 1849 

♦Lewis C. Beck, New York 1850 

♦John C. Torrey, New York 1850 

♦George B. Wood, Philadelphia 1853 

H. a. Buttolph. Short Hills, N. J 1854 

♦ASHBEL Woodward, Franklin, Conn 1861 

♦Thomas W. Blatchford. Troy, N. Y 1861 

♦Jeremiah S. English, Manalapan, N. J 1867 

♦Stephen Wickes. Orange. N. J 1868 

♦S. O. Vanderpool. Albany. N. Y 1872 

♦Joseph Parrish, Burlington, N. J 1872 

♦Ferris Jacobs, Delhi, N. Y 1872 

C. A. Lindsley, New Haven, Conn 1872 

Wm. Pepper, Philadelphia 1874 

S. WiER Mitchell, Philadelphia 1876 

Cyrus F. Brackett. Princeton, N. J 1880 

♦Joseph C. Hutchinson, Brooklyn. N. Y 1880 

Thomas Addis Emmett, New York 1884 

♦Isaac E. Taylor, New York 1884 

♦D. Hayes Agnew. Philadelphia 1886 

♦Jos. Leidy, Philadelphia 1886 

Frederick S, Dennis, New York 1893 

♦John H. Ripley, New York 1893 

Virgil P. Gibney, New York 1893 

William Pierson, Orange, N. J 1894 

Abram Jacobi. New York 1896 

Virgil M. D. Marcy. Cape May City 1896 

Samuel H. Pennington. Newark, N. J 1897 



PERMANENT DELEGATES. 



• ■» • 



Bergen— Henry C. Neer, Park Ridge 1892- 

BURLINGTON-^ J. HOWARD PuGH, Burlington 1892 

N. Newlin Stokes, Moorestown 1 895 

A. W. Taylor, Beverly 1898 

Camden— Alexander Marcey, Riverton 1892^ 

James M. Ridge, Camden 1892 

Duncan W. Blake, Gloucester 1895 

Onan B. Gross, Camden 1895 

William H. Ireland, Camden 189J 

Cumberland — W. H. C. Smith, Millville 1892 

Essex— Arthur Ward, Newark 1892 

Charles Young, Newark 189^ 

Joseph C. Young, Newark 1892 

George Bayles, Orange 1896^ 

Herman C. Bleyle, Newark 1896 

William J. Chandler, South Orange 1896 

Edward J. Ill, Newark 1896 

George R. Kent, Newark 1896^ 

Daniel M. Skinner, Belleville 1896 

Charles H. Bailey. Bloomfield 1898 

Thomas S. Fitch, Orange 189a 

Richard C. Newton, Montclair 1 898 

Joseph D. Osborne, Newark 189a 

William Rankin, Newark 1898 

Joshua W. Read Newark.. 1898^ 

George A. Van Wagenen. Newark 1898 

James T. Wrightson, Newark 1898^ 

Gloucester— George E. Reading. Woodbury 1893 

George C. Laws, Paulsboro 1895. 

James Hunter, Westville 1898 

Hudson— J. D. McGill, Jersey City 1892 

Robert F. Chavert, Hoboken 1 892 

J. A. EXTON, Arlington 1898- 



MEDICAL SOCIETY OF NEW JERSEY. II 

Hunterdon— Isaac S. Cramer, Flemington 1892 

W. S. Creveling, Valley 1896 

Mercer— Cornelius Shepard, Trenton 1892 

R. R. Rogers, Sr., Trenton 1895 

H. M. Weeks, Trenton 1895 

David Warman, Trenton Nom. 1897 

Elmer Barwis, Trenton 1898 

Middlesex— John Helm, New Brunswick 1895 

Edward P. Dana, Metuchen 1898 

Ambrose Treganowan, South Amboy 1898 

Monmouth— Henry C. Cooke, New Brunswick 1892 

Henry Mitchell, Asbury Park 1892 

Morris — I. W. Condit, Dover 4892 

John Stiger. Mendham 1892 

Levi Farrow, Middle Valley 1895 

Passaic— W. B. Johnson, Paterson 1892 

P. A. Harris, Paterson 1893 

George H. Balleray, Paterson 1896 

Salem— B. A. Waddington, Salem 1893 

Somerset— H. G. Wagoner, Somerville 1892 

S. O. B. Taylor, Millstone 1897 

J. P. Hecht, Raritan 1898 

Sussex— Sidn ev B. Strai ley, Andover 1 892 

E. Morrison, Newton 1895 

Union— Alonzo Pettit, Elizabeth 1893 

E. B Silvers, Rahway 1893 

J. ACKERMAN Coles. Scotch Plains 1896 

T. H. Tomlinson, Plainfield 1896 

Warren— John H. Griffith, Phillipsburg^ 1892 

William H. McGee, Belvidere 1896 



Members of District Medical Societies 

REPRESENTED AT THE 

ANNUAL MEETING. 1898. 



It 



4< 



«( 



ATLANTIC COUNTY. 

(District Society organized June 7, 1880. Annual meeting first week in February.) 

W. Blair Stewart, Pres,^ E. H. Madden, Absecon 

Atlantic City Emery Marvel, Atlantic City 

H. C. James, V.-Prgs., Philip Marvel, " 

May's Landing Edward North, Hammonton 

Walter Reynolds. Sec'y &* Treas,, B. C. Pennington, Atlantic City 

Atlantic City W. M. Pollard, 

W. E. Darnsee. Rep., *' W. M. Powell, 

Francis W. Bennett, " Board man Reed, 

T. H. Boy sen, Egg Harbor City Eugene L. Reed, 

E. C. Chew, Atlantic City Talbot Reed, 

A. D. Cuskaden, " Edward A. Reiley, • 

J. M. Elmer, Egg Harbor City E. S. Sharpe. 

W. B. Fayerman, Atlantic City L. R. Souder, 

G. R. Gehring, Bdkersville J. W. Showball, 

C. R. Johnson, Atlantic City J. B. Thompson, 

J. Addison Joy, •* 

No, Members, 28. 

BERGEN COUNTY. 

(Dbtiict Society reorganized February 28, 1854.) 

Howard McFaddcn, Pres., David St. John, Treas,, 

Hackensack Hackensack 

Chas. Calhoun, V.-Prcs., J. W. Proctor, Rep., Englewood 

Rutherford Sam'l E. Armstrong, Rutherford 

Daniel A. Currie, Sec'y, M. S. Ayres, Fairview 

Englewood H. M. Banks, Englewood 



4< 



■ I 



<« 



<« 



14 



MEDICAL SOCIETY OF NEW JERSEY. 



Chas. D. Brooks. Hackensack 
E. E. Conover, Hasbrouck Heights 
Edgar K. Conrad, Hackensack 



J. F. Demund, 
H. C. Elsing, 
John J. Haring. 
Joseph Huger, 
Eugene Jehl, 
J. B. VV. Lansing, 
H. C. Neer, 



Ridgewood 

Ridgefield Park 

Tenafly 

Fort Lee 

Park Ridge 

Tenafly 

Park Ridge 



L. 6. Parsells, 

J. E. Pratt, 

B. D. Stone, 

J. W. Terry, 

A. L. Vandewater, 

William L. Vroom, 

J. A. Wells, 

J. Talmage Wyckoff, 

Samuel J. Zabriskie, 



Cluster 

Schraalenburgh 

Westwood 

Englewood 

Hackensack 

Ridgewood 



Englewood 

Leona 

Westwood 



No. Members, 27. 



BURLINGTON COUNTY. 

(Society organized May 19, 1839] Annual meeting second Tuesday 

A. E. Conrow, Pres., Moorestown W. E. Hall, 

Wm. L. Martin, V,'Pres., J. W. Hollingshead, 

Rancocas B. W. Macfarland, 
A. W. Taylor, Sec'y, Beverly W. C. Fairy, 

E. Hollingshead, Treas., R. H. Parsons, 

P ember ton T. T. Price, 

F. S. Janney, Historian, Riverton J. H. Pugh, 
Joseph Stokes, Rep., Moorestown J. Reeve, 

J. D. Janey, Censor, Cinnaminson Lewis L. Sharp 

Alex. Marcy, " Riverton A. H. Small, 

Wm. P. Melcher. " Mount Holly W. H. Shipps, 

Florence N. N. Stokes, 

Columbus F. G. Stroud, 

Mount Holly Emma R. Weeks, 

Burlington Irene D. Young, 



in April.) 

Burlington 

Afoorestown 

Bordentown 

Mount Holly 



<i 



David Baird, Jr., 
J. E. Dumbell, 
John J. Flynn, 
Franklin Gauntt, 
F. A. Gauntt, 



Tuckertown 

Burlington 

Medford 

Riverside 

Bordentown 

Moorestffiun 
<« 

Riverside 
Bordentown 



K 



CONTRIBUTING MEMBER. 

William Martin, Bristol, Pa. 



HONORARY MEMBERS. 

Chas. p. Noble, 1637 N. Broad St., Chas. H. Thomas, 

Philadelphia, Pa. i6jj Locust St., Phila., Pa. 

E. P. Towasend, Billings, Mont. 

No. Members, 29. 



MEDICAL SOCIETY OF NEW JERSEY. 



IS 



CAMDEN COUNTY. 

(Organized Aug. 14, 1S46. Annual meeting second Tuesday in May.) 



Daniel Strock, Pres., Camden Conrad G. Hoell, 
Wm. S. Jones, V.-Pres., " Frank L. Horning, 

Paul M. Mecray. Sec'y^ 
Jos. L. Nicholson. Treas., 
John G. Doran, Rep,, 



Camden 



ti 



«i 



«« 



Jos. E. Hurff, 
Wm. H. Iszard, 
Hennry Jarrett, 



Blackwood 
Camden 



H. H. Sherk, Hist., Stockton Chas. H. ]tnr\\v\gs, Merchantville 

A\exMMecrsiy,Censor&* Trustee, Wm. B. Jennings, Haddonfield 



Camden Wm. W. Kain. 

H. G. Taylor, Censor &• Trustee, Wm. H. Kensinger, 

Camden Grant E. Kirk, 

£. L.B.Godfrey, Censrr &» Trustee, John F. Leavitt. 

Camden Adrinette LeFevre, 

^^m.H.lrt\aLnil,Censor&» Trustee, A. H. Lippencott, 

Camden Alexander McAlister 

Alex. Marcy, Censer &* Trustee, Frederick W. Marcy. " 

River ton John W. Marcy, Merchantville 

H. A. M. Sm\\k\,Censor ^Trustee, Wm. E. Miller, Camden 

Gloucester Marcus K. Mines, " 



Camden 
Stockton 
Camden 

Blackwood 

Camden 

it 



Jos. S Baer, 


Camden 


J. W. Mortendale. 


Cramer Hill 


W. G. Bailey, 


ti 


Milton W. Osmund, 




Camden 


Duncan W. Blake, 


Gloucester 


Howard F. Palen, 






Chas. S. Braddock. 


Haddonfield 


Wm. H. Pratt. 






W. S. Bray. 


Camden 


Sophia Presley, 






Philip W. Beale, 


t< 


Wm. R. Powell. 






Dowling Benjamin, 


<« 


Jas. M. Ridge, 






John K. Bennett, 


Gloucester 


Frank N. Robinson, 






Sylvan G. Bushey, 


Camden 


Wm. Shafer, 






Robert Casperson, 


«( 


Edw. A. Y. Schellinger, 




Wm. A. Davis, 


<i 


John R. Stevenson. 


Haddonfield 


E. F. DeGrofft, 


It 


Chas. H. Shivers, 




II 


Clarence B. Donges, 


II 


John F. Stock, 




Camden 


John W. Donges, 


II 


Wm. A. Westcott, 




Berlin 


Joel W. Fithian, 


II 


Maximilian West. 




Camden 


Onan B. Gross, 


li 


Jos. H. Wills. 




II 


J. J. Hatey, 


Gloucester 


Wm. P. Wingender. 




4t 


Levi B. Hirst. 


Camden 


E. B. Woolsion, 




Marlton 



l6 MEDICAL SOCIETY OF NEW JERSEY. 

HONORARY MEMBERS. 

G. W. Boughman, Marshalltawriy J. W. Hewlings, Moorestown 

New Castle Co,, Delaware D. P. Pancoast, Mullica Hill 

Richard C. Dean, U, S. Navy J. Orlando White, Camden 

Chas. C. Garrison, Merchaniville J. G. Young, Philadelphia, Pa. 

No. Members, 66. 

CAPE MAY COUNTY. 

(Society organized March xa, 1885. Meets first Tuesday in April and Nov.) 

Wm. A. Lake. Pres., Green Creek I. M. Downs, Court House 

A. L. Leach, V.-Pres., Cape May Chas M. Gandy, U. S. Army 
J. S. Douglass, Secy &* Pep., Coleman Learning, 

Tuckahoe Cape May Court House 

Randolph Marshall, Treas., ** Jonathan Learning, ** 

B. T. Abbott, Censor, Ocean City Joseph Marshall, Tuckahoe 
W. S. Learning, *' Cape May James Mecray, Cape May 
V. M. D. Marcey, " " Emlen Physic. 

N. A. Cohen, Wildwood Eugene Way, Dennisville 

C. B. Corson, South Seaville J. Way, Cape May Court House 

HONORARY MEMBER. 
J. H. Ingram, China. 
No. Members, 19. 

CUMBERLAND COUNTY. 

(Society organized Dec. 8, 1818. Annual meeting second Tuesday in April.) 

A. R. Judson, Pres.^ Newton S. W. Day, Port N orris 

Hamilton Mailly, Secy, Bridgeton H. W. Elmer, Bfidgeton 

Jos. Tomlinson, Treas., " M. K. Elmer, 

J. C. Applegale, Rep., '* Edward Fogg, Shiloh 

O. H. Adams, Vineland John S. Halsey, Vineland 

Eph'm Bateman, Cedarville L. L. Hand, Leesburg 

F. M. Bateman, *' Lester Hummell, Greenwich 
N. H. Burt, Fairton W. L. Newell, Millville 
Alfred Cornwell, Bfidgeton D. H. Oliver, Bridgeton 
J. R. Dare, Deerfield W. F. Sawyer, Vineland 
T. G. Davis, Bridgeton E. B. Sharp, Roadstown 

G. E. Day, Millville Jos. Sheppard, Bridgeton 



MEDICAL SOCIETY OF NEW JERSEY. 



17 



T. J. Smith. 
W. H. C. Smith, 
Ellsmore Stites, 
A. W. Sullivan, 
S. M. Snyder. 



J. R. C. Thompson, Bruigeton 

Millville J. W. Wade, Millville 

Bridgeton J. B. Ware, Bridgeton 

Shiioh C. W. Wilson, Vineland 

Greenwich 



ASSOCIATE MEMBERS. 

W. E. Ashton. Philadelphia, Pa, W. W. Keen. Philadelphia. Pa. 
J. M. Barton, " " Chas. O. Oliver, 

B. C. Heist, 

No. Members, 33. 



ESSEX COUNTY. 

(Society organized June 8, x8i6. Annual meeting first Tuesday in April.) 



Charles F. Underwood, Pres,, 



Levi W. Case, 



Montclair 



Newark William J. Chandler, South Orange 



L. Eugene Hollister. V.-Pres., Robert W. Chapman, 

Newark Albion W. Christian, 



Archibald Mercer. Secy, 
Charles D. Bennett, Treas., 
William S. Disbrow, Rep., 
William B. Arnold, 
Maurice Asher, 



J. Henry Clark, 
' Henry L. Coit, 

Everit P. Courtright, 
Orange Theodore W. Corwin, 
Newark Mathias S. Crane, 



Newark 

Irvington 

Newark 



4< 



*« 



Charles. H. Bailey, 
Aaron K. Baldwin. 
Samuel H. Baldwin, 
George Bayles, 
Frederick W. Becker, 
Herman C. Bleyle, 
John H. Bradshaw, 
Rudolph Brown, 



Bloom field William H. K. Davis, East Orange 
Newark john Dennis, Newark 

Richard G. P. Dieffenbach, " 
Orange Daniel M. Dill, 
Newark Waller Dodge, Orange 

Arthur C. Dougherty, Newark 
Orange John L. Duryee, '* 

Newark Wells P. Eagleton, 



William M. Brien, Orange Valley David J. Edwards, 



tt 



James S. Brown, 


Montclair 


Thomas P. Edwards. 


f< 


Walter R. Bruyere, 


Neivark 


Julius Egge, 


«< 


William Buermann, 


•t 


David E. English. 


Millburn 


Edward L. Burns, 


«4 


James R. English, 


Irvington 


Robert L. Burrage, 


>« 


Thomas D. English, 


Newark 


Charles N. BQttner, 


Orange 


Joseph Fewsmith, 


%t 


William E. Carrol, 

8 


Newark 


Thomas S. Fitch, 


Orange 



i8 



MEDICAL SOCIETY OF NEW JERSEY. 



i< 



<i 



«< 



(I 



i< 



<( 



tt 



»t 



Paul Fitzgerald, Newark 

Richard P. Francis, Montclair 

R. D. Freeman, Orange Valley 

Albert Frey, Newark 

Ruel S. Gage, 

William Gauch, 

Robert F. Gilliin, 

Herman A. Glatzmayer, 

William Glatzmayer, 

William M. Goodwin, 

William B. Graves, East Orange 

Thomas N. Gray, '* 

Chauncey B. Griflfith, Newark 

Charles W. Hagen, 

Joseph F. Hager, 

John F. Hagerty, 

Frederick W. Hagney, 

Eleanor Haines, " 

Levi W. Halsey, Montclair 

Edward H. Hamill, Newrak 

Mary Harley, " 

Thomas N. Harvey, Orange 

E. Zeh Hawks, Newark 

Joseph H. Haydon, 

John Homsath, 

Hugh C. Hendry, 

Henry I. Herold, 

Hermann C. H. Herold, 

Livingston L. Hinckley, 

James S. Hoffman, 

Edgar Holden, 

William H. Holmes, Orange 

John C. Houston, Newark 

Charles L. Ill, 

Edward J. Ill, 

Elias llifT, 

Frederick C. Jacobson, 

William M. Johnson, 

Jotham C. Johnson, 



<i 



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«« 



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William A. Judson, Newark 

George R. Kent, 
Charles J. Kipp, " 

J. M. W. Kitchen, East Orange 
F. E. Knowles, South Orange 
Henry A. Kornemann. Newark 
Charles Lehlbach, '* 

Jesse D. Lippincott, Newark 

Frank W. Lock wood, £Vrj/ Orange 
Herbert W. Long, Newark 

Thomas W. Loweree, 
Calista V. Luther, 
Ernest M. Lyon, 
Henry D. McCormick, 
Floy McEwen, 
William H. McKenzie, 
James M. Maghee, Orange 

William H. Martland, Newark 
Henry E. Mathews, Orange 

Sarah R. Mead, Ne^vark 

Pancrazio Megaro, '* 

Franklin M. Meyer " 

Andrew M. Mills, 
W. D. Mitchell, East Orange 

Clement Morris, Newark 

Frederick C. Nadler, " 

Albert B. Nash, 
Emanuel Newman, •* 

Richard C. Newton, Montclair 
Joseph D. Osborne, Newark 

Edward E. Peck. Caldwell 

Samuel H. Pennington, Newark 
William Pennington, Irvington 
Edward D. Phelan, Newark 

Thomas F. Phelan, Orange 

George B. Philhower, Nut ley 

William Pierson, Orange 

Robert C. Potter, Newark 

Henry A. Pulsford, South Orange 



MEDICAL SOCIETY OF NEW JERSEY. 



19 



<« 



(I 



«< 



«• 



<l 



• f 



tt 



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John M. Rand. Newark 

Charles D. Randall. 

William Rankin, Jr., 

Joshua W. Read, 

Philip Ricord, 

Charles D. Ripley, 

Samuel £. Robertson, 

Benjamin A. Robinson, 

Manning W, Robinson, 

W. D. Robinson, East Orange 

Hugh P. Roden, Newark 

William J. Rober, 

Robert H. Rogers, 

George W. Rolerfort, 

Mefford Runyon, South Orange 

Charles A. Schureman. Newark 

Emanuel Schwarz, 

Edward Sealy. 

William F. Siedler, 

Marco Seidman, 

William F. Shick, 

M. Herbert Simmons, Orange 

Danniel M. Skinner, Belleville 

Anna L. Smith, Montclair 

D. Winans Smith, Newark 

Joseph F. Somerhof, " 

Edward Staehlin, 

Robert G. Stanwood, " 

Joseph W. Stickler, Orange 

Joseph S. Sutphen, Newark 

Roliert M. Sutphen, '* 

Theron Y. Sutphen, *' 

No. Members, 190. 



<< 



t< 



«i 



<< 



K 



James S. Taylor, Orange 

Charles E. Teeter. Newark 

J. Francis E. Tetreault, Orange 

Frederick W. Thum, Newark 

Henry A. Towle, ** 

Sidney A. Twinch, " 

Herbert B. Vail. 

M. H. Cash Vail, Vailsburg 

George A. Van Wagnen, Newark 

George M. Wait, 

David L. Wallace, 

Henry J. F. Wallhauser, 

Aaron C. Ward, 

Arthur Ward. 

Edwin M. Ward, Bloomfield 

Leslie D. Ward, Newark 

William S. Ward. 

William H. Warren. 

Walter S. Washington, 

Frederick Webner, " 

William H. White, Bloomfield 

Henry B. Whitehorne, Verona 

Albert Wickham, Newark 

W. Stockton Wilson. 

Charles H. Winans. Belleville 

Henry M. Woolman, Newark 

Edward E. Worl, 

James A. Wormley. " * 

James T. Wrightson. 

Charles .Young, 

Joseph C, Young 

Charles M. Zeh, 



(< 



•( 



i( 



14 



It 



GLOUCESTER COUNTY. 

(Society organized December, z8i8. Annual meeting in January.) 

Geo. C. Laws. Pres,, Paulsboro Geo. E. Reading, Sec*y &* Treas* 
Chas. S. Heritage, V.-Pres., Woodbury 

Glassboro L. M. HdXs^y, Censor, Willamstown 



20 



MEDICAL SOCIETY OF NEW JERSEY. 



Jas. Hunter, Jr., Censor, WestvilU 
Harry A. Stout, " Wenonah 
Samuel F. Ashcraft, MuUicaHill 



Geo. VV. Bailey. 

William Brewer. 

Chas. M. Burk, 

Henry H. Clark, 

Henry B. Diverty, 

J. Gaunt Edwards, Williamstown 

No. Members, 22. 



Wenonah 

Woodbury 

Clarksboro 

Woodbury 



Eugene Z. Hillegass, Mantua 

Jos. M. Husted, Clayton 

M. Jones Luflfbary, Giassboro 

Eugene T. Oliphant, Bridgeport 

Cyrus B. Phillips, Hnrffville 

Thos. B. Rogers, Woodbnry 
Samuel F. Stanger. Harrisonvilie 

P. E. Stilwagon, Bridgeport 

Howard A. Wilson, Woodbury 



HUDSON COUNTY. 

(Society organued October i, 1851. Annual meeting fint Tuesday in May.) 

Jersey City 



Henry Spence, Pres,., /^sey City 
Chas. K. Law. Secy, 
H. H. Brinkerhofif. Treas., " 
H. H. Burnette, Rep., Hoboken 



Ulamer Allen, 

O. R. Blanchard, 

J. G. L. Borgmeyer, 

W. S. Boyd, 

F. Boyer, 

J. J. Broderick, 

E. P. Buffet, 

E. L. Bull, 

T. R. Chambers, 
R. F. Chavert, 

B. P. Craig, 

J. E. Corrigan, 

F. M. Corwin, 

C. W. Cropper, 
A. Dallas, 

G. K. Dickerson, 
L. F. Donahue, 
E. K. Dunkell, 
Benjamin Edge, 
John R. Everett, 
J. A. Exton, 



Jersey City 



• 4 



Bayonne 
Jersey City 



Hoboken 
Jersey City 



(t 



Bayonne 
Jersey City 

Bayonne 
Jersey City 

Bayonne 
Jersey City 



Arlington 



John Fabcr, 
W. F. Faison, 
J. F. Finn. 
F. D. Gray, 
C. A. Gilchrist, 
L. J. Gordon, 
S. A. Heifer, 
J. P. Henry, 
C. D. Hill, 
P. Hoffman, 
J. C. Kilgore, 
A. J. Kirsten, 
C. F. Kyte, 

F. E. Lambert, 
Mortimer Lampson, 
H. H. Lynch, 

J. D. McGill, 

G. E. McLaughlin, 
J. J. McLean, 

F. \V. Mallaliew, 

E. G. Marks. 
John Nevin. 

F. E. Noble, 
W. J. Parker. 
J. C. Parsons, 



Hoboken 
Jersey City 

Hoboken 
Jersey City 



II 



Bayonne 
Jersey City 



Arlington 
Jersey City 



MEDICAL SOCIETY OF NEW JERSEY. 



21 



W. Pocock, 
C. H. Purdie, 
J. M. Rector, 
J. H. Rosenkranz, 
H. B. Rue. 

No. Members, 60. 



Bayonne G. H. Sexsmith, 
Jersey City H. M. Smith, 

W. P. Watson, 
Hoboken J. E. West, 

Conrad Wienges, 



i< 



Bayonne 
Jersey City 



•< 



«• 



t( 



HUNTERDON COUNTY. 

(Society organized June 13, 182 1. Annual meeting fourth Tuesday in April.) 

Frank Grim, Pres.^ Baptistown A. M. Cooper, Point Pleasant,Pa, 



A. B. Nash, ist V.-Pre^,^ E. W. Closson, 

Frenchtown J. H. Ewing, . 

E. H. Moore, 2d V.-Pres , F. L. Johnson, 

White House M. D. Knight. 

0. H. Sproul, Sec'y, Flemington F. W. Larison, 

1. S. Cramer, Treas,, ** E. D. Leidy, 
Geo. N. Best, Rosemount Peter McGill, 
W. E. Berkaw, Annandale Geo. L. Romine, 
N. B. Boileau. Jutland Jos. Silvara. 

W. S. Creveling, Valley 



Lambertville 

Flemington 

Stanton 

Clinton 

Lambertville 

Flemington 

Lambertville 



<< 



Ringoes 



HONORARY MEMBERS. 

M. Abel, Providence, R. /. W. D. Wolverton, U, S. Army 

No. Members, 19. 



MERCER COUNTY. 

(Society organized May 23, 1848. Annual meeting second Tueiday in May). 



John Bruyere. Pres., 
E. S. Hawke, V.-Pres., 
Geo. N. J. Sommer, Secy, 
Wm. Elmer, Treas., 
George Parker, Rep,, 
Chas. F. Adams, 
Alexander Armstrong, 
Elmer Barwis, 
Henry M. Beaty, 
Chas. P. Britton, 



Trenton A. T. Bruere, 
" F. V. Cantwell, 

" Franklin Chattin, 

W. A. Clark. 

J. C. Craythorn, 

Paul L. Cort. 
** Henry B. Costill, 

A. H. Dey, 
" E. L. Dickenson, 

" Geo. H. Franklin, 



Hightstown 



22 



MEDICAL SOCIETY OF NEW JERSEY. 



J. C. Felty, Trenton 

A. J. Hunt. Hamilton Square 



J. S. Jameson, 
Mozart Jenkins, 
H. S. Johnson, 
Wm. S. Lalor, 
Lyman Leavitt, 
Thos. H. Mackenzie, 
Walter Madden, 
Benj. W. McGalleaid, 
Chas. H. Mcllwanie, 
H. G. Norton, 
N. B. Oliphant. 
R. H. C. Phillips. 
Wm. Rice, 
Elmer H. Rogers, 
R. R. Rogers, Sr., 
R. R. Rogers, Jr., 

No. Members, 55. 



Trenton 

Trenton 

Lawrenceville 

Trenton 



Joseph B. Shaw, Trenton 

Cornelius Shepard, ** 

Ira M. Shepherd, " 

E. B. Skellenger, 
W. D. Stevenson, 
Geo, Silvers, 
" G. Schoennig, 

Wm. McD. Strumble, 
Trenton G. E. Titus, 

W. B. Vanduyn. 

J. W. Ward, 

David Warman, 

Henry M. Weeks, 

J. H. Wikoff, 

Lloyd Wilbur, 

William Wilbur, 

P. W. Yard, Trenton 



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Hightstown 
Trenton 

Hightstown 
Trenton 



Princeton 
Hightstown 



MIDDLESEX COUNTY. 



(Society organised June i6, i£x6. Annual meeting ihird Wednesday in April.) 



<* 



4« 



C. M. S\2iQV.,Pres.,New\Brunswick 
J. L. Suydam, V.'Pres.,Jameslmrg 

D. Sitphens.Secy^New Brunswich 
D. C. English, Treas,, 
A. L. Smith, Rep,, 
H. R. Baldwin. 

J. J. Bissett, Pater son 

S. V. D. Clark, New Brunswick 
Edward B. Dana, Metuchen 

F. M. Donahue. New Brunswick 
John Helm, 



Cranbury 
Metuchen 



<< 



t« 



J. C. Holmes, 

A. C. Hunt, 

Wm. V. Mc Kenzie, 

Wm. M. Moore, 

F. E. Riva, Milltown 

P. A. Shannon, New Brunswick 

H. C. Symmes, Cranbury 

A. Treganowan, South Amboy 

C. H. Voorhees, New Brunswick 

N. Williamson. " 

J. G. Wilson, Perth Amboy 



No. Members. 22. 



MEDICAL 3OCIETY OF NtW JERSEY. 



23 



MONMOUTH COUNTY. 

(Society organized July 16, x8i6. Annual meeting third Monday in May.) 



F. C. Price, Pres,^ Imlaystown 
D. M. For man. Sec'y, Freehold 
A. F. Applegate, Englishtown 
Wm. B. Beach, Eatontawn 

Ellis W. Crater, Ocean Port 

H. G. Cooke, New Brunswick 



J F. Davison, 
V. M. Disbrow, 
Edwin Field 
D. D. Hendrickson. 
H. A. Henrickson, 

Atlantic Highlands 



Asbury Park 

Lakewood 

Rtd Bank 

Middletown 



Wm. M. Hepburn, 
G. Hoagland, 
A. J. Jackson, 
Harris P. Johnson, 
Samuel Johnson, 
W. R. Kinmouth, 
C. Knecht, 



Freehold 

Keyport 

Matawan 

Altentown 

Asbuty Park 

Farmingdale 

dMatawan 



W. U.Kurtz, 
L S. Long, 
S. F. Macintosh, 
Wm. MacMillan, 
J. G. Maynard, 
Henry Mitchell, 
P. B. Pumyea, 
Roberts Edgar, 
Edw. F. Taylor, 
John Taylor, 
Chas. H. Thompson, 
Fred. Thompson, 
W. W. Trout. 
Wm. B, Warner, 
Geo. F. Wilbur, 
Alex. Williamson, 
W. S. Whit more. 
Scudder Wooley, 



EatontoTvn 

P'reehold 

Asbury Park 

PerrinevilU 

Freehold 

Asbury Park 

AllentoTvn 

Keyport 

Afiddletown 

Ocean Grave 

Belmar 

Holmdgl 

Spring Lake 

Red Bank 

Asbury Park 



<t 



Red Bank 
Long Branch 



HONORARY MEMBERS. 

Robert Laird, Manasquan J. B. Goodenough, Long Branch 

J. E. Arrowsmith, Keyport 

m 

No. Members, 36. 



MORRIS COUNTY. 

(Society organized June i, 1815. Annual meeting second Tuesday in May ) 

T. P. Prout, Pres,, Morris Plains P. C. Barker, Morristown 

J. Walters. V,'Pres., Port Oram G. A. Becker, 

Levi Farrow, Sec'y, L. W. Case, Montclair, Essex Co* 

Middle Valley A. E. Carpenter, Boonton 

J. B. Sliger, Treas , Mendham T. R. Crittenden, Dover 

E. R. Cooper, Rep., Troy Hills A. W. Condict, 

N. H. Adsit, Succasunna I. W. Condict, •• 

C. Anderson, Madison R. L. Cook, '* 



24 



MEDICAL SOCIETY OF NEW JERSEY. 



G. 0. Cummins, 


Dover 


A. A. Macwithey, 


Pompton 


Harris Day. 


Chester 


P. S. Mallon, 


Morris Plains 


H. V. Day, 


Bloomingdale 


C. N. Miller, 


Flanders 


G. S. DeGroot, 


Mendham 


L. L. Mial, 


Morristown 


James Douglas, 


Morrislown 


F. W. Owen, 


«< 


B. D. Evans, 


Morris Plains 


S. Pierson, 


«( 


Jacob W. Farrow, German Valley 


S. H. Reed, 


Madison 


Jas. R. Farrow, 


«« 


Wm. H. Risk. 


Summit 


G. W. Flagge, 


Rockaway 


J. B. Risk, 


«i 


G. H. Foster, 


Rockaway 


J. G. Ryerson, 


Boonton 


W. S. Foster, 


Flanders 


G. M. Swain, 


Chatham 


Elliot Gorton, 


Morris Plains 


E. Sutton, 


German Valley 


H. A. Henriques, 


Morrislown 


J. L. Taylor, 


Boonton 


B. M. Howley. 


«i 


H. C. Upchurch, 


Chatham 


H. W. Kice, 


Port Oram 


C. Wigg, 


Boonton 


A. A. Lewis, 


Morrislown 


W. J. Wolfe. 


Chatham 


H. B. McCarroll, 


t( 







HONORARY MEMBER. 

C. Y. Swan, Morrislown 



No. Members, 48. 



PASSAIC COUNTY. 

(Sodety organized July 14, 1844. Annual meeting third Tuesday in 

H. Kip, Pres., 1 

J. M. Stewart, V.-Pres., 
R. M. Curtis, Sec'y, 
George Fisher, Treas., 
M. A. Mackintosh, Rep., 
W. B. Johnson, Censor, 
T. J. Kane, 
W. K. Newton, " 

F. E. Agnew, 
A. Alexander, 
R. R. Armstrong, 
J. W. Atkinson, 

G. H. Balleray, 
J. H. Banta, 



Apri.) 



« 



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«« 



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ti 



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J. S. Bibby. 


Paterson 


D. T. Bowden, 


(t 


J. A. Browne, 


«« 


V. E. BuUen, 


«< 


W. Blundell. 


■« 


W. H. Carroll. 


Passaic 


W. S. Colfax. 


Pompton 


D. R. Crouse, 


Passaic 


G. S. Davenport, 


Garfield 


S. De Jager, 


Paterson 


F. F. G. Demarest, 


Passaic 


E. W. Doty, 


Paterson 


Herbert S. Emerson, 


I* 


T. F. Fitzmaurice, 


It 



MEDICAL SOCIETY OF NEW JERSEY. 



25 



AVilliam Flintcroft, 


Paterson 


J. R. Paxton 


Paterson 


0. V. Garnett. 


(• 


A. W. Rogers, 


44 


. J. T. Gillison, 


«( 


B, H. Rogers. 


44 


M. W. Gillison, 


<« 


G. T. Rundle. 


Passaic 


P. A. Harris, 


« 


C. H. Scribner, 


Paterson 


J. H. Henggeler, 


«t 


J. W. Smith. 


44 


A. D. Jousset, 


t4 


W. R. Smith, 


Little Falls 


J. L. Leal, 


(« 


R. Stinson, 


Paterson 


H. H. Lucas, 


tl 


J. Sullivan. 


Passaic 


A. F. McBride, 


11 


M. J. Synott. 


Little Falls 


J. C. McCoy, 


«( 


C. Terriberry. 


Paterson 


B. J. Marsh, 


«• 


G. W. Terriberry, 


44 


J. R. Merrill. 


« 


R. H. Terhune, 


Passaic 


S. R. Merrill, 


<« 


P. H. Terhune, 


44 


E. B. Morgan, 


«t 


S. Van Dalsen, 


Paterson 


•C. F. W. Myers, 


44 


C. S. Van Riper, 


• 4 


R. Neer, 


44 


C. Van Riper, 


Passaic 


W. Neer. 


44 


G. Van Vraken, 


44 


J. F. O'Donncll, 


44 


George Vreeland. 


Paterson 


T. F. O'Grady, 


44 


F. Vigna, 


44 


H. Park. 


44 


J. W. Williams. 


44 


T. T. Paton. 


• 4 







J. c. 

No. Members, 71. 



HONORARY MEMBER. 

Herrick, Colorado Springs, CoL 



SALEM COUNTY. 

(Society organized May 4, x88o. Annual meeting, first Weduesday in May.) 



Alloway W. H. James, Censor and 

Rep,, Pennsville 
F. Bilderback, Salem 

W. H. Caq>enter, " 

R. M. Davis, 



W. L. Ewen, Pres., 

N. S. Hires, V.-Pres.. Salem 

Henry Chavanne, Sec'y and 

Treas,, " 
H. T. Johnson, Censor and 

Rep, Pedricktown G. W. H. Fitch, 
Daniel Garrison, Censor and W. T. Good, 

Rep,, Pennsgrove L. H. Miller, 

B. A. Waddington, 



Daretown 

Quinton 

Woodstown 

Salem 



26 



MEDICAL SOCIETY OF NEW JERSEY. 



HONORARV MEMBERS. 

H. M. Q\\nsXiaLT\; Philad^iphia, Pa. James Hunter, 

E. E. DeGroffz, Camden Capt. C. Mcllvain, 

Geo. Freehes. Pkiladelphiay Pa. Mordecai Price. 

£. B. Gleason, 

H. A. Hare, 

L. M. Halsey, Williamsiown 

J F. Hamilton, Philadelphia^ Pa. 

No. Members, 13. 



(I 



<• 



«« 



tc 



B. T. Shumwell, 
Charles E. Tumbull, 
H. A. Wilson, 



Westville- 
Phila.. Pa. • 



<i 



t« 



«( 



Woodbury 



SOMERSET COUNTY. 

(Society organised May, 1816. Annual meeting last Thunday in April.) 



W. G.W^digowtv, Pres.,Somirville I. Fisher, 

S.O.h.T2i)\ov.V.'Pres.,A\fillstone T. H. Flynn, 

J. P. Hecht, Secy, Raritan Mary E. Gaston, 

W. H. Merrejl, Treas., J. F. McWilliam, 

Soulh Branch B. B. Matthews. 

A. L. Stilwell, Rep.y Somerville A. Nelson, 
J. E. Anderson, 
J. B. Beekman, 

Middlebush 

North Branch F. A. Wild, 

Bound Brook P. J. Zeglio, 

HONORARY MEMBER. 

John W. Ward, Trenton. 

ASSOCIATE MEMBER. 

E. R. Voorhees. M.D.C, Somerville. 
No. Members, 21. 



Harlingen 

Somerville 



J. H. Cooper, 
H. V. Davis, 
C. R. P. Fisher, 



Neshanic L. T. Reed, 
Pluckemin W. B. Ribble, 
W, J. Swinton, 



Bound Brook 

Neshanic 

Somerville 

East Millstone 

Somef ville 

Bound Brook 

North Plain field 



SUSSEX COUNTY. 

(Society organized August as, 1829.) 

H. D. Van Gaasbeek, Pres., L. G. Burd, 

Decker town Martin Cole, 

Bruno Hood, V.-Pres., Newton J. P. Course, 

S. B. Straley, Secy, Andover E. Dalrymple, 

E. Morrison, Treas., Newton C. K. Davidson, 

T. H. Andress, Sparta C. E. Dowling; 



Ogdensburg 

Hainsville 

Hamburg 

Branchville 

Stanhope 

Sparta 



MEDICAL SOCIETY OF NEW JERSEY. 



21 



B. W. Ferguson, BeemervilU J. F. McCloughan, 



Jos. Hedges, 
P. N. Jacobus, 
J. N. Miller, 
J. C. Moore, 



Carlos Allen, 

No. Members, 21. 



BranchvilU J. IJ. Pellet, 

Newton j. C. Price. 

•• John Strader, 

Deckertmvn S. Voorhees, 

HONORARY MEMBkRS. 
Vernon E. Schurno. 



Swart swood 
Hamburg 

Branchville 

Lafayette 

Nt wton 

BranchvilU 



UNION COUNTY. 

(Society organiied June 7, 1869. Annual meeting second Wednesday in April.) 



James S. (ire en, Pres., Elizabeth 
E. B. Grier. V.-Pres., 
J. B. Harrison, Sec'y, Westfield 
R. J. Montfort, Treas., Elisabeth 
R. B. Whitehead, Pep., 



F. C. Ard, 
F. R. Bailey, 
W. C. Boone, 
T. F. Burnett, 
J. H. Carman, 
W. E. Cladek. 



Plainfield 

Elizabeth 

Plainfield 

Elizabeth 
•« 

Rahway 



J. Ackerman Coles. Scotch Plains 



F. M. Corwin, 
M. L. Clowson, 
Thomas Dolan, 

A. Q. Donovan, 

G. W. Endicott. 
J. R. English, Jr., 
W. F. Gaston, 
William Gale, 

B. Van D. Hedges, 

E. W. Hedges, 
H. Page Hough, 
T. J. Jackson. 
S. J. Keefe, 

F. A. Kinch, 

No. Members, 52. 



Bergen Point 

■ Plainfield 

Elizabeth 

Plainfield 
Irvington 
Plainfield 
Westfield 
Plainfield 



(( 



Springfield 
Elizabeth 
Westfield 



T. F. Livengood, 
M. B. Long. 
Victor Mravlag, 
C. W. McConnell, 
J. K. McConnell, 
T. N. McLean, 
W. A. M. Mack, 
W. H. Murray 
E. R. O'Reilly. 
Alonzo Petiit. 
H. C. Pierson, 
J. B. Probasco, 
S. T. Quinn, 
John M. Randolph, 
J. P. Reilly. 
W. M. Selover, 
A. Stem, 

E. B. Silvers. 
R. R. Sinclair, 
G. W. Strictland. 
Charles H. Schlichter, 
T. H. Tomlinson. 

W. F. Turner, 
N. W. Voorhees, 

F. W. Westcott, 
N. L. Wilson, 



Elizabeth 

Plainfield 

Elizabeth 

Cr an ford 
<< 

Elizabeth 
<< 

Plainfield 
Elizabeth 

Roselle 
Plainfield 
Elizabeth 
Plainfield 
Elizabeth 

Rahway 
Elizabeth 

Rahway 

Westfield 

Roselle 

Elizabeth 

Plainfield 



t( 



Fanwood 
Elizabeth 



28 MEDICAL SOCIETY OF NEW JERSEY. 

WARREN COUNTY. 

Scciety organized February 15, 1896. Annual ineeting first Tuesday in June.) 

F. W. Curtis, Pres,, Stewartsville F. W. Haggerty, Vienna 
A. P. Jacoby, V.-Pres., L. B. Hoagland, Oxford 

Phillipsburg John C. Johnson, Blair st own 

Wm. J. Burd, Sec'y, Belvidere Wm. Kline, Jr., Phillipsburg 

Wm. H. McGee, Treas,, " Louis C. Osmun, Hackettstown 

J. H. Griffith, Rep.^ Phillipsburg L. C. Osmun, Washington, D, C 

W. C. Albertson, Belvidere J. M. Reese, Phillipsburg 

M. N. Armstrong, Newton C. B. Smith, Washington^ N,J, 

Isaac Barber, Phillipsburg Wm. Stites, 

H. O. Carhart, Blairstown G. O. Tunison, Oxford 

John S. Cook, Hackettstown Alva C. Van Syckle, Hackettstown 

G. W. Cummins, Belvidere 

No. Members, 22. 



SUMMARY. 



Atlantic, 


- 28 


Middlesex, 


22 


Bergen, 


27 


Monmouth, 


- 3^ 


Burlington, 


- 29 


Morris, 


48 


Camden, - 


66 


Passaic, - - . 


■ 71 


Cape May, 


- 19 


Salem, 


13 


Cumberland, 


33 


Somerset, 


- 21 


Essex, - 


- 190 


Sussex, 


21 


Gloucester, 


22 


Union. - 


- 52 


Hudson, 


- 60 


Warren, 


22 


Hunterdon, 


19 






Mercer, - 


■ 55 




85+ 



TRANSACTIONS 



OF THE 



Medical Society of New Jersey. 



One Hundred and Thirty-Second Annual Meeting. 



held in the auditorium, asbury park, n. j.. 

June 28, 29 and 30, 1898. 



FIRST DAY— TUESDAY, JUNE 28TH. 

The meeting was called to order by the President, Dr. 
David C. English, of New Brunswick, at 3.30 p. m. The 
session was opened with prayer by Rev. A. S. Bale, of 
Asbury Park. 

Dr. W. J. Chandler presented the report of Com- 
mittee on Credentials. The Committee recommended 
that the informality in the certificates be overlooked 
this year, but that next year the certificates be pre- 
sented in proper form. 

Dr. Walter B. Johnson, of Paterson, inquired if the 
understanding was that the names of those gentlemen 
^ho had been nominated for permanent delegates, and of 
whose nominations the Secretary had received notifica- 
tion from the district societies, would stand before this 
Society for election in the absence of credentials pre- 
sented by them. 

The President stated that the report of the Committee 
^was before the Society. The first question involved was 
regarding those who had presented certificates not in 
regular form. The recommendation in the report was 



32 MEDICAL SOCIETY OF NEW JERSEY. 

that such be received at this time, but notification was- 
given that hereafter all such certificates must conform 
to the requirements of the Constitution, which specifies- 
even the exact language of these certificates. On the 
other hand, if persons had been nominated as permanent 
delegates to the Society, and their certificates were not 
in the hands of the oflflcers of the Society, they certainly 
could not be considered at the present time. 

It was moved, and seconded, that the report be 
accepted. 

It was then moved, as an amendment, that the dele- 
gates who had been regularly certified to the Society as 
permanent delegates, should be voted upon. This was,, 
however, ruled out of order, and the report was then 
accepted without a dissenting vote. 

The roll was then called. 

Atlantic — E. C. Chew,* J. A. Joy,* B. C. Pennington,* E. L. Reed,"^ 
E. A. Reiley. Members, 28. 

Bergen — Samuel E. Armstrong,* G. H. Mc Fadden,* J. W. Proctor,* 
D. Si. John,* William L. Vroom.* Members, 27. 

Burlington—], W. HolHngshead,* W. C. Parry. T. T. Price,* J. 
Reeve, William H. Shipps, Emma P. Weeks.* Members, 29. 

Camden— Do^Xmg Benjamin, Alex. McAlister, W. A. Davis, Max. 
West. J. F. Leavill. A. H. Lippencott, J. S. Baer, John R. Stevenson. 
Members, 66. 

Cape May—\, M. Downs,* William A. Lake,* V. D. M. Marcy,* 
Randolph Marshall,* Eugene Way.* Members, 19. 

Cumberland — J. Rulon Dare, M. K. Elmer,* L. L. Hand, D. H* 
Oliver, Ellsmore Stites. J. B. Ware. Members, 33. 

Essex — L. Eugene Hollister, Livingston S. Hinckley, Edward 
Staehlin.* Robert G. Stanwood,* Joseph F. Somerhof,* W. P. Eagleton, 
Robert M. Sutphen,* T. Y. Sutphen, James S. Taylor,* J. Francis 
Tetreault, Sidney A. T winch. Henry A. Towle, Frederick W. Thum, 
Charles Lehlbach. A. K. Baldwin, J. W. Corwin, David L. Wallace,. 
Fayette Smith, W. B. Graves, Edwin M. Ward, R. C. "Newton. 
Members, 190. 



MINUTES. 33 

Gloucester — J. Gaunt Edwards, Eugene Z. Hillegass, Eugene T. 
Oliphant,* Harry A. Stout,* Howard A. Wilson.* Members, 22. 

Hudson^]o\iVi }. Broderick,* T. R. Chambers, S. A. Heifer, C. D. 
Hill, J. D. McGill, John J. Nevin, M. Lampson, Henry B. Rue.* W. R. 
Watson. Members. 60. 

Hunterdon — W. E. Berkaw, E. W^ Closson,* Frank Grim,* A. B. 
Nash.* Members, 19. 

Mercer— ]Q\)Xi Bruyere,* F. V. Cantwell,* A. J. Hunt,* B. W. 
McGalliard,* N. B. Oliphant, G. N. J. Sommer, G. Schoennig,* G. E. 
Titus.* Members, 55. 

Middlesex — Edward B. Dana, J. L. Suydam Ambrose Treganowan, 
N. Williamson * J. G. Wilson.* Members, 22. 

Monmouth — William B. Beach,* C. Knecht,* William R. Kinmouth, 
I. S. Long, William MacMillian,* F. C. Price, John Taylor.* Mem- 
bers, 36. 

Morris — Calvin Anderson, G. O. Cummings,* A. E. Carpenter, L. 

F. Bishop, H. A. Henriques.* Members, 48. 

Passaic— ]o\ii\. R. Merrill, R. M. Curts, G. T. Rundle, J. T. Gillson, 

G. S. Davenport, H. Kip,* A. F. McBride, M. A. Mackintosh, J. C. 
McCoy, Frank Agnew. Members, 72. 

Salem— G. H. W. Finch,* Daniel Garrison, W. H. James, W. H. 
Carpenter. Members, 13. 

Somerset — J. E. Anderson,* I. Fisher,* J. H.Cooper,* T. H. Flynn,* 
L. T. Reed.* Members, 21. 

Sussex — Bruno Hood,* E. Morrison,* J. C. Moore,* J. B. Pellet,* 
S. B. Straley.* Members, 21. 

Union — ^James S. Green, J. B. Harrison, F. A. Kinch,* T. N. 
McLean, N. L. Wilson, E. W. Hedges, W. U. Selover, A. Stem.* 
Members, 53. 

Warren—^, C. Albertson,* Isaac Barber,* W. J. Burd,* L. C. 
Osmun, J. M. Reese.* Members, 22. 

OFFICERS PRESENT. 

President, David C. English ; Vice-Presidents, C. R. Fisher, Lather 
M. Halsey, William Pierson ; Corresponding Secretary, E. L. B. 
Godfrey; Recording Secretary, William J. Chandler; Treasurer, 
Archibald Mercer ; Standing Committee, William D. Iszard, Stephen 
Pierson, Henry W.Elmer, Henry Mitchell, M. Lampson, Charles Young. 



•Absent. 

t 



34 MEDICAL SOCIETY OF NEW JERSEY. 



FELLOWS PRESENT. 

John C. Johnson, Franklin Gauntt, Henry R. Baldwin, Alexander 
W. Rogers, B. C. Barker, Charles J. Kipp, John W. Ward, H. Genet 
Taylor, Elias J. Marsh, John G. Ryerson, O. H. Sproul, William 
Elmer, T. J. Smith. 

PERMANT DELEGATES PRESENT. 

Bergen, Henry C. Neer; Burlington, J. Howard Pugh; Camden, 
D. W. Blake, William H. Ireland, Alexander Marcy; Essex, Herman 
C. Bleyle, Edward J. 111. George R. Kent, Daniel M. Skinner, Joseph 
C. Young ; Gloucester, George Evans Reading ; Hudson, J. D. McGill ; 
Hunterdon, William S. Creveling, Isaac S. Cramer ; Mercer, R. R. 
Rogers. Sr., Cornelius Shepard ; Monmouth, Henry C. Cooke, Henry 
Mitchell; Morris, I. W. Condit, John Stiger; Passaic, George H, 
Balleray, P. A. Harris, W. B. Johnson ; Salem, B. A. Waddington ; 
Somerset, S. O. B. Taylor, H. G. Wagnor ; Union, J. A. Coles, Alonzo 
Pettit, E. B. Silvers, T. H. Tomlinson. 

Dr. Henry Mitchell, of Asbury Park, chairman of the 
Committee of Arrangements, presented his report. He 
said that this was the fifth occasion on which this Society 
had met in Asbury Park, and the third on which it had 
been his duty to serve as chairman of the Committee of 
Arrangements. No concessions had been asked for from 
the railroads, because of the low excursion rates already 
established from all portions of the State to Asbury Park. 
The use of the Asbury Park Auditorium had been 
donated by Mr. Jas. A. Bradley, who had more than once 
shown his good feeling towards this Society. 

The speaker said that quite recently there had been 
set up a very handsome and interesting set of salt water 
baths, and the proprietor had very kindly placed at his 
disposal one hundred free tickets for the members of 
the Society. 

At the meeting of the mayor and council of Asbury 
Park last evening, the coming of the Society had been 



MINUTES. 35 

noticed by a very handsome preamble and resolution, 
and a committee of the council was appointed to appear 
at one of the sessions. 

Dr. Mitchell also called attention to the fact that the 
Asbury Park beach, which last year seemed to be dis- 
appearing, is returning, and is extending seaward rapidly 
every day, apparently as a result of the action of the jetties. 
During the past year much has been done in the way of 
improving the public water supply of Asbury Park, so that 
it is now satisfactory in every way. Another improvement 
which had been going on for a number of years, related 
to the collection of the refuse in the locality. It 
was in view of the position of Asbury Park as a health 
and pleasure resort, that the officers of the town are will- 
ing to spend $4,900 for the proper collection of rubbish, 
garbage and ashes. 

Dr. Skinner moved that the report of the Committee 
of Arrangements be accepted, with the thanks of the 
Society, and the Committee discharged. Seconded, and 
carried. 

Dr. E. L. B. Godfrey, of Camden, Corresponding Secre- 
tary, presented his report. (See Appendix). 

On motion, the report was accepted. 

Corrections. — Dr. Pugh, of Burlington, stated that he 
had not absented himself from the meetings of the 
Society for any three consecutive sessions. 

Dr. Godfrey replied that the printed records stated 
that he had been absent in 1896 and 1897, but he took 
pleasure in making the correction in accordance with Dr. 
Pugh*s statement. 

Dr. Skinner said that the name of Dr. Lott Southard 
had been recommended from the district society as a 
permanent delegate. 

The Committee on Credentials explained that he was 



36 MEDICAL SOCIETY OF NEW JERSEY. 

not a permanent delegate until he had been reported 
here, and elected by this Society. 

Dr. W. B. Johnson moved that a committee of three 
be appointed by the chair to make an apportionment of 
the permanent delegates, which should be fair and equit- 
able to every one of the district societies of the State 
of New Jersey. This motion was offered, he said, be- 
cause of misunderstandings which had occurred from 
time to time since the original election of permanent 
delegates. Certain societies are not reported at all, and 
certain others only partially. 

The point of order was raised that this was not the 
regular order of business, and the point was sustained by 
the chair. 

The Minutes of the last annual Meeting were read 
in abstract by the Secretary. 

On motion, the minutes, as printed in the Transactions, 
with two or three minor corrections, were approved. 

Dr. William Pierson, of Orange, moved that the Secre- 
tary call the names of those whose credentials as perma- 
nent delegates had been presented in accordance with 
the requirements of the By-Laws. Seconded, and carried. 

This list was read by the Secretary. 

Dr. Reading appealed from the decision of the chair 
regarding the Society having already acted upon the 
regularity of the certificates. The chair was sustained. 

Dr. Benjamin then moved that the Secretary cast the 
ballot for the names, as read. Seconded. Objection 
being made that this can only be done by counties, the 
list for each county was read, and the delegates for each 
county were elected by a ballot cast by the Secretary. 

The Secretary announced that the certificates of Dr. 
W. A. Davis and Dr. M. Cuthbert Wigg, while undoubt- 
edly authentic, were not in proper form. 



MINUTES. 37 

On motion, the Secretary was empowered to cast a 
ballot for the election of these two gentlemen. This was 
done, and they were declared duly elected delegates. 

The Secretary announced that the secretaries of the 
county societies had sent the following names without 
any certificates, and merely with the statement that 
they had been elected permanent delegates. (List read.) 

Dr. M. Lampson, of Jersey City, said that the Society 
had no right to elect these gentlemen under the circum- 
stances, and he therefore objected to any election. 

Dr. Shephard moved that all such names lie over until 
the next annual meeting, and that, in the meantime, 
proper and legal certificates be prepared by the county 
societies. Seconded by Dr. Young. 

Dr. Charles Young, of Newark, said that the by-laws 
do not state that the secretary must immediately send the 
certificate ; hence it would be quite regular, provided the 
election were held in 1898 at the regular annual meeting 
of the district society. 

Dr. E. B. Silvers moved, as an amendment, the 
addition of the words: '' Except such as furnish proper 
certificates during this annual meeting.** Seconded and 
carried. The original motion, as amended, was then 
carried unanimously. 

Dr. W. B. Johnson, chairman, presented the report of 
Business Committee. (See Appendix.) 

On motion, the report of the Committee was accepted. 

Dr. W. B. Johnson then moved that the action of the 
Bridgeport Association, and also the action of the Union 
County Society, be referred to the Committee on Ethics 
for report at the next annual meeting, if they see fit to 
make a report. Seconded and carried unanimously. 

The President announced the following committee to 
audit Treasurer's report: Drs. Skinner, Shephard and 
Hecht. 



38 MEDICAL SOCIETY OF NEW JERSEY. 

Dr. Godfrey moved that the matter of the ambiguity 
of the by-laws, with reference to the permanent delegates, 
be referred to a special committe of five, with the Record- 
ing Secretary as Chairman, to report at the next annual 
meeting. Seconded, and carried unanimously. 

Dr. William Pierson moved that this committee be 
empowered to make any suggestions regarding changes 
in the by-laws in this connection. Seconded and carried 
unanimously. 

Dr. Benjamin moved that this action be considered a 
notification of change of by-laws with reference to perma- 
nent membership. Seconded and carried unanimously. 

Dr. H. W. Elmer, chairman, said that as no special 
matter had been brought before the Committee on 
Ethics and Judicial Business for consideration, there was 
no formal report. 

Dr. Archibald Mercer, of Newark, presented the report 
of Treasurer. (See Appendix.) 

The following list of bills to be paid, was also read : 
Dr. H. W. Elmer, Standing Committee, $20; Dr. E. L. 
B. Godfrey, Corresponding Secretary, $20.08 ; Dr. Henry 
Mitchell, I5. 50; Dr. W. J. Chandler, Recording Secretary, 
$28.24: Orange Chronicle, $25 ; Dr. A. Mercer, Treasurer, 
$1 1.38 ; Loans and interest, $1,155.82 ; Dr. O. C. Ludlow, 
Stenographer, $65. 

Dr. Skinner moved that the Treasurer be authorized 
to borrow an amount considered sufficient to meet the 
expenses. Seconded, and carried. 

It was also moved that the bills referred to in the 
Treasurer's report, be ordered paid and that the assess- 
ment for the coming year be two dollars. 

The Corresponding Seccretary presented a communica^ 
tion from the Medical Society of the State of Pennsylvania, 
stating that Professor Charles K. Mills had been ap- 
pointed an accredited delegate to the Society; also a 



MINUTES. 39 

communication from the New Jersey Pharmaceutical 
Association, stating that Drs. S. D. Woodbay, of Ocean 
Grove, George E. Williams, of Asbury Park, and F. F. 
Coleman, of Asbury Park, had been appointed delegates 
to this Society. 

It was moved, seconded and carried, that delegates 
from sister societies, and the Rev. A. S. Bale be invited 
to all the privileges of the floor. 

Dr. H. G. Taylor, chairman of the Committee on 
Honorary Membership, recommended that Dr. Samuel 
Hayes Pennington, who was President of this^ Society 
fifty years ago, should be made an honorary member. 

It was moved that the report be received, and its 
recommendation be adopted. By a rising vote, the 
recommendation was unanimously adopted. 

Dr. C- J. Kipp moved that the Secretary be instructed 
to send a telegram to Dr. Pennington, informing him of 
his election as honorary member, congratulating him on 
this, the golden anniversary of his presidency of the 
Society, and expressing the regret of the Society that he 
is unable to be present on this occasion. The motion 
was carried unanimously. 

Dr. J. W. Stickler, chairman of the Committee on 
Legislative Action on Bovine Tuberculosis (continued 
from last year), presented his report. He said that 
they had had a conference with the Tuberculosis Com- 
mission, something which they had not been able to 
secure before; it was found that the commission was con- 
siderably hampered in its work, yet it was endeavoring, in 
a conservative way, to popularize the movement. They 
expressed their willingness to have the Committee co* 
operate with them. 

After reading the formal report. Dr. Stickler said that 
he thought progress could be best made by co-operation 
with the Tuberculosis Commission 



40 MEDICAL SOCIETV OF NEW JERSEY. 

It was then moved that the report be received and the 
Committee continued, and that it be requested to confer 
with the Tuberculosis Commission. 

Dr. Mitchell said that he had been present at one of 
the meetings of the Committee at which Dr. Stickler 
had presided. At this meeting the people representing 
the agricultural interests showed a willingness to join with 
the medical profession in this eflfort to restrict the spread 
of bovine tuberculosis. Every one who had examined 
the statute as it stood today, knew that the law was 
totally inadequate to cope properly with the great and 
growing danger. The medical profession should have 
been the leaders in this matter from the outset. 

The motion was carried. 

Dr. T. J. Smith, in the absence of the chairman 
of the Committee on President's Address of Last Year, 
Dr. Barker, reported that the Committee had held 
a meeting in Trenton, and had drawn up a bill 
having for its object the establishment of an epi- 
leptic colony in New Jersey. They succeeded in having 
the bill passed by both houses of the legislature, and 
signed by the Governor, and an appropriation of $15,000 
made for carrying out its provisions. In this way, the 
instructions of the Committee had been carried out with 
complete success. 

On motion, the report was received, with the thanks of 
the Society for the untiring efforts of the Committee in 
behalf of this great class of unfortunates. 

Dr. Skinner, for the Committee on Treasurer's report, 
reported that it had examined the Treasurer's accounts 
and the vouchers for the same, and had found them 
correct, as presented in the report of the Treasurer. 

On motion, the report was approved. 

On motion, the Society adjourned at 5.45 p. m. 



MINUTES. 41 

EVENING SESSION. 

The meeting was called to order by the First Vice- 
President, Dr. C. R. P. Fisher, of Bound Brook, at 8.15 
p. m., and the annual address of the President was then 
delivered by Dr. David C. English, of New Brunswick, 
who took for his topic, " Patriotism in the Medical Pro- 
fession." 

At the conclusion of the address. Dr. English was 
tendered the thanks of the Society, and was requested 
to furnish a copy of it to the Standing Committee for 
publication. 

Dr. Henry W. Elmer, of Bridgeton, presented the 
report of Standing Committee. (See Appendix). 

Dr. Henry Mitchell, of Asbury Park, presented the 
report on Progress in State Medicine and Hygiene. (See 
Appendix.) 

Dr. William H. Iszard, of Camden, presented the report on 
Progress in Medicine and Therapeutics. (See Appendix.) 

Dr. Charles Young, of Newark, presented the report on 
Progress in Surgery. (See Appendix.) 

Dr. E. Fayette Smith presented the report on Progress 
in Diseases of the Nose and Throat. (See Appendix.) 

On motion, the reports of Drs. Lampson and Bolton 
were made the first order of business at the next morning 
session. 

The following gentlemen were announced as the Nom- 
inating Committee : 

Burlington, Franklin Gaunt; Camden, D.Benjamin; Cumberland, 
L. L. Hand ; Essex, J. T. Wrightson ; Gloucester, £. Z. Hillegass ; 
Hudson, John Nevin ; Hunterdon, W. E. Berkaw; Mercer, N. B. 
Oliphant ; Monmouth, W. R. Kinmouth ; Morris, C. Anderson ; Pas- 
saic. W. B. Johnson; Salem, W. H. Carpenter; Somerset, H. G. 
Wagoner ; Union, Jas. S. Green ; Warren, L. C. Osmun. 

On motion, the Society adjourned at 11.00 p. m. 



42 MEDICAL SOCIETY OF NEW JERSEY. 

SECOND DAY— WEDNESDAY, JUNE 29TH. 

The meeting was called to order by the President, at 
9.30 a. m. 

Dr. B. Meade Bolton, of Princeton, presented the 
report on Progress in Bacteriology. (See Appendix.) 

Dr. E. J. Ill moved that all further reports of the Stand- 
ing Committee be read by title only, and be referred to the 
Standing Committee for publication. Seconded, and 
carried unanimously. 

Dr. Lampson presented, by title, a paper on " progress 
in Diseases of the Eye and Ear." (See Appendix.) 

The President announced the appointment of the 
following on the Committee on Permanent Member- 
ship: Dr. W. J. Chandler, chairman ; Dr. W. B. Johnson, 
Dr. E. L. B. Godfrey, Dr. J. H. Pugh and Dr. Henry 
Mitchell. 

The remainder of this session was devoted to the read- 
ing and discussion of the following scientific papers: 

Essay, by the Third Vice-President, William Pierson, 
M.D.— "The Umbilical Chord." (See Appendix.) 

Dr. W. B. Johnson moved that this essay be received 
and referred to the Standing Committee for publication. 
Seconded, and carried unanimously. 

Dr. Philander A. Harris moved that the Society invite 
Dr. Charles P. Noble, of Philadelphia, an Honorary Fel- 
low of the Burlington County Medical Society, to partici- 
pate in the proceedings of the Society. Seconded, and 
carried unanimously. 

Dr. W. B. Johnson moved that Drs. Judson Daland 
and William B. Atkinson, of Philadelphia, and Prof, 
Turnbull, of the University of Pennsylvania, also be 
invited to take part in the proceedings of the Society. 
They were so invited by unanimous consent. 



MINUTES. 43 

Report of Case of Foreign Body in the Oesophagus ; 
Retro-pharyngeal Oesophagotomy. — John C. McCoy, 
M.D. (See Appendix.) 

Report of Case of Foreign Body in Bronchus ; Trache- 
otomy. — Walter B. Johnson, M.D. (See Appendix.) 

On motion, the two foregoing reports were received 
and referred to the Standing Committee. 

Dr. E. J. Ill, of Newark: "This case of Dr. Johnson 
has been very interesting to me, because my first surgical 
experience was with a shawl pin in a bronchus. I do 
not thjnk the trachea should ever be closed by suture ; 
the wound in the trachea should be left widely open, in 
my opinion. In cases in which closure has been made, I 
have observed considerable emphysema ; in one case so 
severe as to result in death." 

Dr. J. W. Stickler, of Orange : " I performed trache* 
otomy on a child several years ago, and after the tube 
was inserted I directed the nurse to keep it cleansed with 
a feather. She did this for a time, and then, having lost 
the feather, she improvised an instrument by tying a piece 
of gauze on the end of a feather. This became detached, 
and I found it afterward lodged in the left bronchus. I 
divided the soft tissues down to the sternum, and opened 
the trachea clear down to the bifurcation. The child was 
struggling and apparently dying. I removed the gauze 
without any difficulty, and then brought together the 
trachea up to the first division. The case was one of 
diphtheritic croup, and the child, I think, would have 
died anyway. I had no difficulty in removing the gauze 
after making this complete division of the trachea." 

Dr. W. B. Johnson : " With reference to Dr. McCoy's 
case, I would say that I was present at the operation, 
and we made a considerable eifort to remove the foreign 
body with the forceps, but without success. The opera- 



44 MEDICAL SOCIETY OF NEW JERSEY. 

tion having been completed, the wound was closed tightly 
with sutures and the patient made a complete recovery^ 
This seemed to indicate the wisdom of completely closing 
the incision, at least in that case, the healing process 
having extended only over a period of sixteen days. In 
my own case, the trachea was also tightly closed. There 
was no inconvenience or harm resulting from it. The 
escape of air from a tracheal wound underneath the skin 
is not of material importance, and is observed in many- 
tracheotomy cases when no effort is made to close the 
tracheal wound. The trachea in my case was pimply- 
brought together, and there was no escape of air through 
the line of incision, and whatever air escaped was under 
the skin. I believe that the operative procedure having- 
been made in a thoroughly aseptic manner, and under 
satisfactory conditions, it is entirely proper to close these 
wounds completely by suture, without regard to the 
question of drainage. If inflammation should occur, I 
do not believe it would extend so far that it would be 
impossible to open the wound and pack it, should this be 
required. Leaving the wound open and packing it at 
the time of the operation, means a tedious convalescence 
of perhaps three weeks or more." 

Dr. Cantwell, of Trenton : " During the past three 
years I have had occasion to do tracheotomy over fifty 
times in membranous croup, once for foreign body. I 
have never sutured the trachea, and have never even 
sutured the skin. I have always allowed the wounds to 
granulate. Out of this number there were five or six 
deaths. These patients did not remain in hospital longer 
than two weeks. Several of them have been examined 
by me at various times after leaving the hospital. The 
scar was found to be very small and not especially notice- 
able. In one of these cases it became necessary to do a 



MINUTES. 45 

second tracheotomy for membranous croup about two 
years after the first operation. There was no difficulty 
in entering the trachea. I have never observed any 
emphysema, and have never used either a ligature or a 
suture." 

Dr. Judson Daland, of Philadelphia : ** I have been 
•extremely interested in the case reported by Dr. McCoy, 
and have been delighted with the results obtained. The 
only thought which occurs to me is with reference to the 
use of distilled water. It seems to me that if distilled 
water is given soon after operation, this water will not 
remain long free from micro-organisms, because there are 
many such in the buccal cavity. On theoretical grounds, 
it would seem, therefore, that better results might be 
obtained by giving the oesophagus at least twenty-four 
hours of absolute rest, depending entirely upon giving 
water by the rectum or abstaining from giving it alto- 
gether. 

"With regard to Dr. Johnson's paper, I would say that 
his case was extremely fortunate, particularly as regards 
the seizure of the foreign body by the forceps. Such a 
body as a bean is very hard to handle, and moreover, its 
enlargement by absorption of moisture adds to the diffi- 
culties of the case. I can recall two cases of foreign 
bodies in the bronchi, occurring some years ago. The 
first was a case in which a carpet tack remained in the 
bronchial tube for several years. The other was a case 
in which a peanut shell lodged in a bronchus. When the 
foreign body is not removed, there result bronchiectasis, 
circumscribed interstitial pneumonia and continued cough 
and expectoration. All these disastrous consequences 
were avoided by the prompt operative interference in the 
case just reported." 

Dr. McCoy : " We realized that the buccal cavity was 



•-^ "MICAL SOCIETY o„ 

.^ y ■>»» C.3.. .h?,^,'"'" » period Of !. •"^"'■n/p 

=: == ^o, o, „;-;" i-^-Cea, woJ::" ""^ '-"• i 

»=. nought ,„ ■ The trachea ,„ ' ""<'« to 
-«=»-.= line of °„"'""<"llere was" '' "^= «■- 

,=. =.t.Vacton, cl^. '°'°°el>iy aseor ^ P'-^r 

— °""* -Ce i^t " ^''"S;';r""" 

a inpossibl, ,„™ " would exi,„j '">" slic 

«=»«■ Perhaps ,1 °P"Mio„, „„ °P'" and 

I''- Can, " "-"ta „; " ' " '=*ou 

^.""'".aveh'd°'Tre„,o„/; 

*'°""=veT3t""''"or„nl°';'"che. 

ewnulate A'"' ' have a, ' '' '"d 
deaths. Th ' "f 'hi, „ "■"^'^ »llo„ 

;'""-»::?T"'^<'""ot""'" 

•^■vmeatv. Several ,' '^Wai 

^^''- In° "'•"hevel, ''"«vi„, '" > hoy ..^ 



"hen 

■0' into 

'" «iiti. 

'■ »"d the 

'"'"■as an 

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47 

.e a 

wipe 

. the 

ever de- 
if growth 
nd, there- 
is contam- 
The only 
It Dr. Klein 
vill coagulate 
ot only do all 
are capable of 

. ** In my opinion, 

. esentation of sub- 

,'. In the selection 

1 that the action of 

J conserve the public 

ibjects coming before 

that of prophylaxis is 

ou take the history of 

lied to tuberculosis or 

, in their various relations 

or milk, the highest type 

today will be prophylaxis. 

in to cure. The gentlemen 

facts to us have done so in 

it should precipitate action. 

iwing that beef tea will grow 

tubercle bacillus or the germ- 

>s we reduce this knowledge to 

ny object for many years to see 

J people who entrusted themselves 



46 MEDICAL SOCIETY OF NEW JERSE\. 

not an aseptic region ; nevertheless, it was thought that 
we could diminish the chances of infection by using the 
sterilized water. We cannot give the oesophagus abso- 
lute rest, because it is engaged in swallowing saliva from 
time to time." 

Discussion on ** Milk as a Culture Medium, and its Capa- 
city to Spread Infectious Diseases." Opened by R. C. 
Newton, M.D., and continued by John L. Leal, M.D., 
Joseph W. Stickler, M.D., H. R. Baldwin, M.D., H. L. 
Coit, M.D., and others. (See Appendix.) 

On motion of Dr. Chambers, the papers of Drs. Newton, 
Leal and Stickler were received, with thanks, and referred 
to the Standing Committee, with the recommendation 
that they be published, and that a committee of five be 
appointed to consider the recommendations in Dr. New- 
ton's paper. Dr. Newton being made chairman. 

Dr. J. W. Stickler, of Orange. He said that the com- 
position of milk makes it a nutritive medium for every 
germ, the biology of which is- understood. Milk always 
contains bacteria unless drawn with special precautions 
into a sterilized flask. In the udder of a healthy cow it 
is sterile. An investigation in Boston showed that when 
healthy cows were carefully milked in a clean dairy into 
a sterilized flask, 530 bacteria were found per cubic centi- 
meter, but when the ordinary milk pail was used, and the 
milking was conducted in the common way, there was an 
average of 30,500 bacteria per cubic centimeter immedi- 
ately after milking. 

As an example of methods of contamination, he said 
that he had recently gone to a house in which a boy was 
sick with diphtheria. The boy took a drink of milk from 
a tumbler, and then the unused portion was placed upon 
the table. This milk could very easily convey the dis- 



MINUTES. 47 

ease to others. Again, he had seen the mother take a 
towel upon which the child had expectorated, and wipe 
a tumbler with it, before pouring the milk into the 
tumbler. 

The germs of diphtheria, cholera and scarlet fever de- 
velop at the ordinary room temperature, and their growth 
does not affect the appearance of the milk, and, there- 
fore, one cannot tell whether or not the milk is contam- 
inated simply from its gross appearance. The only 
exception, perhaps, to this statement is, that Dr. Klein 
claims that the germs of cow scarlet fever will coagulate 
the milk at a temperature of 35^ C. Not only do all 
known germs develop in milk, but they are capable of 
living in milk. (Partial Appendix). 

Dr. H. R. Baldwin, of New Brunswick : " In my opinion, 
nothing is more important than the presentation of sub- 
jects of this nature before this Society. In the selection 
of this subject last year I considered that the action of 
this Society would be such as would conserve the public 
health. I believe that of all the subjects coming before 
us as students of state medicine, that of prophylaxis is 
of the greatest importance. If you take the history of 
the germ disease, whether applied to tuberculosis or 
scarlet fever or typhoid fever, in their various relations 
of propagation through water or milk, the highest type 
of action of the physician of today will be prophylaxis. 
It is far better to prevent than to cure. The gentlemen 
who have presented these facts to us have done so in 
such a cogent way that it should precipitate action. 
What is the value of knowing that beef tea will grow 
the bacillus, whether the tubercle bacillus or the germ- 
producing cholera, unless we reduce this knowledge to 
practice? It has been my object for many years to see 
what I could do for the people who entrusted themselves 



48 MEDICAL SOCIETY OF NEW JERSEY. 

to my care. I never allow my families, if I can help it, 
to use any milk which is not sterilized. When I know 
that in the 6utlying districts of the town in which I live 
the cows lie down in the midst of filth ; when I know 
that the udder is not cleansed, and that these germs can 
be destroyed, I insist upon the use of a sterilizer by all 
of my families. My mind has been thoroughly made up 
as to the method by which diseases of this kind are 
propagated — the diseases ordinarily spoken of as pre- 
ventive diseases. We know perfectly well that if a 
germ is put into a tumbler of beef tea, the germ grows at 
the ordinary temperature, and that after a time it can be 
injected into an animal, and that immunization will after 
awhile take place. But why go through this long pro- 
cess if we can go to work and prevent the very inception 
of this whole process? I am sorry that such 'a small 
number of persons is present to listen to this vital sub- 
ject, and I am not sure but that in time a much wider 
interest will be evinced." 

Dr. T. R. Chambers, of Jersey City : " I wish to say 
that Dr. H. L. Coit was the pioneer in this State in 
determining the questions relating to disease in cattle, 
and its dissemination through milk. Through the labors 
of Dr. Coit, we have in Newark what is known as * cer- 
tified milk'; a pure milk which has been placed within 
the reach of all. The method has been copied in 
Buffalo. We have with us, Mr. Francisco, who started 
this dairy business in accordance with Dr. Coit's ideas. 
I hope this Society will give him an opportunity to 
speak on this subject." 

The President here invited Mr. Stephen Francisco to 
speak. 

Mr. Francisco: **I have very few thoughts to present to 
you extemporaneously on this occasion, and while I 



MINUTES. 49 

thank Dr. Chambers, I cannot give you any important 
information regarding our work. I think Dr. Graves, 
who is here, could give you more information. I would 
gladly extend to you, however, an invitation to come and 
inspect out dairy and its workings, and in our exhibit 
downstairs, we have a series of interesting photographs 
designed to throw light on the method of conducting 
the dairy." 

Dr. Hedges, of Plainfield: "One year ago we had in 
our town between eighty and ninety mild cases of scarlet 
fever. The health board found much difficulty in tracing 
the source of this epidemic, but finally traced it to the 
milk. They investigated the water, the ice and the milk 
supplies. It was at last discovered that a certain milkman 
had two sons who had had scarlet fever, and these boys 
were peddling the milk while desquamation was still 
active upon them. It was found that people who took 
the milk and those who took ice cream soda from estab- 
lishments supplied with his milk, alike developed scarlet 
fever. As an instance of the perversity of human 
nature, and the selfishness of man, I would say that 
although they were detected and ordered by the health 
board to desist from business, they came into town the 
following day. Their business could not be stopped 
until they were arrested, and their milk destroyed. 
These men were originally attended by a homoeopathic 
physician who told them they did not have scarlet fever." 

The President then announced the appointment of the 
following committee on the recommendations of Dr. 
Newton's paper: Dr. Richard C. Newton, chairman ; Drs. 
Talbot R. Chambers, H. L. Coit, Henry R. Baldwin and 
John L. Leal. 

Dr. T. R. Chambers, as delegate to the Massachusetts 



50 MEDICAL SOCIETY OF NEW JERSEY* 

State Society, reported : " I was a delegate from this 
Society to the Massachusetts State Society. I was struck 
by the courtesy of the society in sending me a notice that 
whatever could be done to make me comfortable at 
Boston would be done, if I would communicate with the 
proper officer. I found that the society met in the new 
part of Boston. 

" The meeting opened at ten o'clock, a series of opera- 
tions being performed by the surgeons, fifteen minutes 
being allotted for each. It was kept up from ten o'clock 
in the morning until five o'clock in the afternoon, the 
intervals being filled in with papers. I saw one surgeoni 
operate with gloves, and his assistants and nurses also- 
wore gloves. He claimed that his results were better for 
so doing. They also had a stereopticon exhibition going 
all day. On the last day twelve hundred sat down to a 
most orderly banquet. The head waiter in the gallery 
controlled all the others by signals with a flag. 

" Another point of interest and significance was, that 
their membership numbers 2,400, and fifty per cent, of 
the members are often at their meeting. Those desiring 
to be admitted to this society must pass a very rigid ex- 
amination and many are rejected again and again/* 

The Secretary anounced the fact that Dr. Pierson had 
attended the British Medical Association, as delegate ; 
also the receipt from Dr. Silvers of his report as delegate 
to the New York State Medical Society. 

Dr. Chandler moved that all reports of delegates,, 
already presented or to be presented, be referred to the 
Standing Committee for publication. Seconded, and 
carried. 

Dr. Kent, delegate from the Connecticut State Society,, 
was introduced, and said : ** Mr. President, and members 
of the Medical Society of New Jersey: I shall not 



MINUTES. 51 

inflict a speech upon you, but simply express my grati- 
tude for being able to be with you as a representative 
of the Connecticut Medical Society, and also as a co- 
worker in search after truth as it relates to medicine and 
surgery. Though many of us are minor lights in the 
profession, I think we are all interested in this search 
for truth, and desire to keep abreast with the times 
as far as we are able. I consider it, therefore, a great 
privilege to be present at a meeting like this, where 
we hear from representative men of the State. The Con- 
necticut Medical Society sends you her most cordial 
greeting and expresses the hope that the fraternal feeling 
which has existed between the two societies in the past, 
shall not only continue, but shall be strengthened in the 
future. I have with me two or three resolutions which 
were passed by my society in New Haven, in May, and 
at the proper time I would be pleased to read them, as I 
have been instructed to present them for your con- 
sideration." 

The President : " We shall be glad to hear from you now. 
Dr. Kent, regarding them." 

Dr. Kent then read the resolutions. 

The following resolutions were adopted by the Connecticut Medical 
Society, at its annual meeting in New Haven, June 7, 1898 : 

Resolved, That the Secretary of this society be instructed to write 
to the Senators from Connecticut, that it is the opinion of the mem- 
bers of the Connecticut Medical Society that the legislation embodied 
in Senate Bill 1063 is uncalled for, and hence unwise ; that in its scope 
it is prejudicial to scientific medical research ; that it is mischievous 
and inquisitorial and prohibitive in its details, and if carried out it 
will prevent the employment of some of the most beneficial measures 
for the combating of disease and the prolonging of life that the 
world has known. 

Resolved, That it is the glory of the medical science of the century 
that the average of human life has increased by more than ten years. 



52 MEDICAL SOCIETY OF NEW JERSEY. 

and we assert that this has been brought about in a very great meas- 
ure by the study of physiological and biological processes, as exempli* 
(ied in and investigated by experiments upon animals. We regard 
these experiments to be as completely justified as is the employment 
of animal food to sustain life, and we most earnestly and respectfully 
urge upon the honorable Senators from the State of Connecticut to 
oppose by legitimate means, the enactment of legislation that would 
in any way interfere with scientific research, and is unauthorized by 
the Society for the Prevention of Cruelty to Animals in the District of 
Columbia. 

Resolved, That the delegates of this society to other State Societies 
and Associations are requested to bring this subject in proper form to 
the voters of these societies and associations, and to ask them to take 
corresponding action. 

N. E. WORDIN, Secretary. 

The President replied : " In behalf of the Medical 
Society of New Jersey, we desire to express our pleasure 
in receiving today, the delegate from the Connecticut 
Medical Society, and we would ask him to carry to that 
society our most cordial greeting. We recognize the 
good work done by that society, and the fact that the 
oldest honorary member of this State Society today, is 
Professor C. A. Lindsley, of New Haven. He was elected 
an honorary member in 1872. 

" With reference to the resolution presented, setting 
forth the action of the Connecticut Medical Society on 
the anti-vivisection bill now pending in Congress, I would 
merely say that the Medical Society of New Jersey took 
action last year upon that subject, similar to the action 
taken by the Connecticut Society this year. We trust 
that the relations existing between these two societies 
may always by maintained." 

The Society adjourned at 12.30 p. m. 



MINUTES, 5 J 

AFTERNOON SESSION, 

The Society reconvened, at the call of the President, 

at 3.30 p. m. 

The following essays were read and discussed : 

** Uterine Displacements," by H. B. Costill, M.D., 

Trenton. (See Appendix.) 

Dr. E. J. Ill, of Newark: "There are two forms of dis- 
placement to which the paper did not refer. The ordi- 
nary form of retroflexion and retroversion we can treat 
very well, but there are two forms which have caused 
me much anxiety. One of them is a simple retroposi- 
tion that occurs most frequently in unmarried, or sterile 
married women. It is due to a shortening of the utero- 
sacral ligaments of the peritoneum of Douglas* cul-de-sac. 
When the utero-sacral ligaments are shortened, these 
patients suffer from backache, nervous disturbances, and 
especially, occipital headache. They always suffer more 
or less from menstrual disturbance, and iir former days, I 
believe this was due to contraction of the cervical canal. 
This condition may be treated in two ways. Up to six 
or eight months ago, it was my custom to put these 
patients under an anaesthetic and very thoroughly stretch 
the utero-sacral ligaments. Then I dilated the uterus, 
inserted a glass plug and gauze in the vagina. During 
the last few months, a gentleman from Boston, who has 
evidently encountered this condition, has advised that 
the abdomen be opened, the utero-sacral ligaments cut 
and a ventral fixation done. I have done this operation 
once, and the patient is doing so well that I shall probably 
resort to this operation in the future in the less severe 
forms. 

" Another form not spoken of in the paper is the lateral 
displacements of the uterus. If there is anything which 



54 MEDICAL SOCIETY OF NEW JERSEY. 

is likely to make a woman an invalid, it is this lateral dis- 
placement. In the congenital form of lateral displace- 
ment, the woman begins to suffer on reaching puberty. 
The pain is located on the long ligament, and it is first 
noticed chiefly after she has been on her feet a good deal, 
probably because the long ligament has to bear all the 
strain. In these cases, if they are at all severe, stretching 
of these ligaments gives no relief. In such cases it 
seems to be necessary to extirpate the uterus and the 
broad ligaments to afford relief. The acquired form 
occurs perhaps after a miscarriage, or after contracting 
specific disease. She suffers on the shorter ligament, and 
the condition is much more amenable to treatment than 
the first form." 

Dr. Charles P. Noble, of Philadelphia : '* This paper 
is so sound that, in discussing it, one must discuss rather 
one's own experience. I quite agree with the author of 
the paper with reference to anteflexion. We were all 
taught that anteflexion was a frequent pathological con- 
dition and required rather active treatment. Various 
pessaries and operations were devised for the treatment 
of this condition, but I agree with the reader of the 
paper that it is seldom due to anything else than congenital 
arrest of development, or to peritonitis with contraction 
of the utero-sacral ligaments drawing the central part of 
the uterus backward, and then the intra-abdominal pres- 
sure pushing the fundus down. Like Dr. Costill, I think 
the symptoms which are produced are the result either 
of stenosis of the cervix, or of endometritis, and that 
the only operative treatment called for is dilatation of 
the cervix and curettment. 

**The question as to the treatment of retro-displace- 
ments has been discussed in the paper, and I find the 
author is in favor of ventral fixation. In simple cases 



MINUTES. 55 

Tequiring operation, I personally prefer the shortening of 
the round ligaments. My experience with the two 
operations is about the same ; I suppose I have done 
ventral fixation about 150 times and the Alexander oper- 
ation about 125 times. When either operation is applic- 
able, I believe the shortening of the round ligament gives 
a distinctly better result. I also prefer the Alexander 
operation in women of child-bearing age, for the excellent 
reason that in (juite a number of cases in which preg- 
nancy has subsequently occurred, the condition left after 
this operation has seriously complicated the pregnancy 
and labor. We should avoid this fixation of the uterus. 
The name * ventral fixation * is a very bad one. Any 
method of operating which aims to secure a broad attach- 
ment between the uterus and abdominal wall is a bad 
operation from the obstetrical side, although it is suffi- 
ciently satisfactory from the standpoint of the gynecolo- 
gist. In quite a number of these cases it has been 
necessary to resort to the Porro operation to effect 
delivery. 

** In the classification of retroversions, the reader of 
the paper made two classes — those with, and those with- 
out, adhesions. I think we should go further, and say 
that many cases of retroversion with adhesions are prob- 
ably not cases of displacement of the uterus, but diseases 
of the uterine appendages, and the mere position of the 
uterus is an accidental matter. I think that fact should 
be borne in mind, for the position of the uterus is a 
trifling matter compared with the disease of the append- 
ages. Whenever the uterus is found adherent, one 
-should not rest satisfied in diagnosing a retro-displace- 
ment, but should carefully determine whether or not the 
uterine appendages are sound or diseased. In this par- 
ticular class of cases, when operation is demanded, my 



56 MEDICAL SOCIETY OF NEW JERSEY. 

own experience leads me to believe that it is better^ 
instead of removing the uterine appendages, and follow- 
ing this by attaching the uterus to the abdominal wall, 
to do a hysterectomy, and so get rid of the uterus, as well 
as the appendages. In those cases, as a rule, the uterus 
is not healthy, but septic, and after removal of the 
appendages, there are extensive raw surfaces behind the 
uterus. The pelvic cavity is left much more healthy if 
the uterus is removed with the appendages. My experi- 
ence has been, that such cases make a much smoother 
convalescence than when the appendages are removed 
and the uterus is attached to the abdominal wall. 

** I was very much pleased with what has been said 
about procidentia, for I have had occasion to operate 
upon over 1 50 of these cases, and I am sure that the pro- 
positions in the paper are most sound. While it is 
essential to restore the pelvic floor, this is not sufficient to 
effect a cure ; the proper method is to curette the uterus* 
amputate the cervix, operate under the bladder to take 
up the slack from the presence of the cystocele, restore 
the pelvic floor by a properly performed perineal opera- 
tion and then suture the uterus to the abdominal walL 
Regarding the technique for suturing the uterus to the 
abdominal wall, I would say, that the best method seems 
to me to be the attachment of the uterus to the peri- 
toneum with light silk sutures. There are no less than 
64 methods of sewing the uterus to the abdominal wall^ 
so that there is abundant room for the exercise of 
personal preference. I have adopted the method which 
has given such excellent results in Dr. H. A. Kelly's 
hands, and which has been used more widely perhaps 
than any other. It consists in lightly sewing the uterus 
to the peritoneum with two fine silk sutures. This 
attaches the uterus to the abdominal wall without fixing 



MINUTES. 57 

it. Unless a number of silk-worm gut sutures are buried, 
I think that no matter what method is used, the uterus 
will pull loose in a certain number of cases. Even then 
one or two per cent, of the cases will pull loose. 

*' The rules laid down in the paper about the use of 
pessaries are eminently wise. Too much should not be 
expected of the pessary. It is often expected to do good 
when the uterus is adherent ; certainly an impossibility. 
Even when the most approved methods are used, the 
percentage of cases in which a cure can be effected, is 
very small. Those who have carefully studied their 
cases and reported them, have not claimed to cure more 
than 15 or 20 per cent, with pessaries. These cases are 
almost exclusively retroversions occurring after labor ; the 
most favorable class." 

Dr. Costill : " I have not met with many cases of retro- 
position such as were described by Dr. Ill, and in these 
there were very few symptoms. The lateral displace- 
ments I simply mention without going into detail. I 
tried to make the point that the uterus is not attached, 
but is merely approximated to the abdominal wall until 
it has acquired a natural forward position, and the intra- 
abdominal pressure will maintain it there." 

" School Hygiene, with Reference to the Production of 
Ocular Disease," by W. B. Johnson, M.D., Paterson. 
(See Appendix.) 

Dr. William B. Atkinson, of Philadelphia: "I do not 
think I can add anything to the very valuable paper just 
presented, but it is such an important subject that I hope 
no member present will fail to consider it more fully, and 
make it his duty, as far as he may have influence in his 
locality, to see that school boards attend to these wants 
of our children. In the coming number of * Public 



^58 MEDICAL SOCIETY OF NEW JERSEY. 

Health' there will appear a very valuable paper on 
'* Medical Inspection of School Children,* by Miss Dora 
Keen, daughter of Dr. W. W. Keen, of Philadelphia. On 
the subject of school buildings, a valuable paper was 
published in the April number of the same journal. 
This paper was read before your State Sanitary Associa- 
tion, at its meeting, at Lakewood. I wrote to Mr. Loring, 
the author, to send me his paper for publication. 

** Our children all over this broad land are being 
injured, especially as regards their sight. I am here now 
an example of what children often suffer in their school 
xlays. I had no glasses and did not know that I was 
nearsighted. As a result I was compelled to continually 
make up my time, simply because I did not have the 
ability to see what was placed before me. I know of no 
subject which has been brought before this Medical 
Society of New Jersey which is of such great importance 
to the rising generation as is this one." 

Dr. R. C. Newton : " It seems to me that we should 
try to educate the teachers. They understand, in a 
general way, about the direction in which the light 
should come, but they are very backward in their know- 
ledge of ventilation. At one time, I read a paper before 
some teachers, giving them a test for determining the 
contamination of the air by carbonic acid gas. The test 
consisted in shaking up the air with lime-water in a 
bottle ; if it became cloudy, it showed great contamina- 
tion. At the close of the paper, one of the teachers 
asked me, if by shaking up the bottle of lime-water, one 
could purify the air in the room? Proper ventilation 
seems to be largely a matter of luck with the architect. 
I think we must depend to a great extent upon the 
windows for the admission of fresh air. I do not think 
that there is any good reason why teachers should not 



MINUTES. 59 

pass an examination in hygiene before being permitted to 
teach. This, it seems to me, could be done, and it cer- 
tainly ought to be." 

Dr. Johnson : ** I think Dr. Atkinson is quite right 
about the importance of this subject, and I am in hopes 
that the State Board of Health may do something in the 
matter of issuing such circulars as have been sent out by 
the New York State Board of Health. It is true that 
the teachers need instruction on these matters, but many 
others in the community need this instruction just as 
much. There is a growing feeling in the community 
that something must be done in the way of reforming 
these matters. I do not agree with Dr. Newton regard- 
ing ventilation ; I believe that any system of ventilation 
which depends upon the force of a blower-fan, having a 
certain capacity, and which is in connection with absolutely 
tight flues, the fans being both at the ingress and egress 
of air, may be made efficient. Such a plan is, however, 
very expensive, not only in its first cost, but in its main- 
tenance. These facts must be realized. It is difficult to 
get school boards to build schoolrooms which are large 
enough to secure 250 cubic feet of air to each pupil. 
Physicians do not hesitate about supplying the requisite 
amount of air-space in a hospital, but it is another matter 
with the school boards." 

"The Care of Chronic Cardiac Disease, with a Con- 
sideration of Results," by L. F. Bishop, M.D., New 
York. (See Appendix.) 

Dr. John C. Johnson, of Blairstown: "Of course, 
ultimately, all these cases of chronic heart disease prove 
fatal, and yet experience shows that this fatal termination 
can be warded off for a considerable length of time. I 
have had under observation for a considerable time, a 



6o MEDICAL SOCIETY OF NEW JERSEY. 

patient who has now reached the advanced age of ninety- 
six. He has had for years a loud, blowing murmur^ 
There has been no increase in the dyspnoea, although he 
occasionally has attacks of syncope. His bowels move 
almost daily, and when they do not, evacuation is secured 
by giving a little phosphate of soda with his oatmeal at 
breakfast. Occasionally, a small dose of calomel is given. 
By its use, any difficulty in respiration is almost immedi- 
ately relieved. In some cases the stomach becomes- 
dilated and pushes up against the heart, causing severe 
palpitation. I recall the case of an old lady, whom I had 
treated for some years for functional disease. I finally^ 
saw her suffering from so much palpitation that I felt 
sure she had reached a stage which would cause much 
trouble, but a few days later I found she was very much 
better. Constipation causes not only a dilated condition 
of the stomach, but also of the colon, and the dilation of 
the latter results in upward pressure on the diaphragm- 
and interference with respiration. It is evident, there- 
fore, that the relief of the constipation is an important 
measure in relieving the action of the heart and diminish- 
ing the dyspnoea. 

** There are two or three remedies which are easily 
used in addition to the cascara. Many of these cases 
suffer severely from flatulence. A good deal of this gas, 
of course, may come from the colon and dilated stomach,, 
and from imperfect digestion. A tablet of rhubarb, aloes 
and gentian, I have found, would quiet this condition of 
the stomach, and if one tablet is given every night, it 
will secure a regular action of the bowel for some time. 
Another plan is to take a solution of Epsom salts, adding 
two drops of the tincture of nux vomica. This addition 
makes the draught more palatable and more effective.*^ 

Dr. Alexander W. Rogers, of Paterson : " My experi- 



MINUTES. 6l 

ence with cascara has not been favorable ; it is not at all 
equal, in my opinion, to the combination of aloin, bella- 
donna and strychnia. I recall one case in which there 
was considerable congestion of the liver and stomach. 
At the autopsy, we found in the stomach a ball as large 
as a cocoanut." 

Dr. Newton : '* In flatulent conditions I have found 
assafetida exceedingly useful when other drugs have 
failed." 

Dr. Bishop : ** I did not have time to read the portion 
of the paper dealing with the treatment of chronic 
cardiac disease by the baths and physical exercise, accord- 
ing to the method of Schott. I think it would be inter- 
esting to have this a subject for discussion at the next 
annual meeting." . 

" The Method of Administering, and the Use of, 
Enteroclysms/' by Judson Daland, M.D., Philadelphia. 
(See Appendix.) 

Dr. Richard C. Newton : " I feel, personally, very much 
indebted to Dr. Daland for his very clear and interesting 
exposition of this comparatively new matter. I won- 
dered, while he was reading the paper, whether or not 
antiseptics had been used in this way. Chlorine water 
has been used with success in cholera, and some of us 
who have used it in typhoid fever have found it satisfac- 
tory because of its antiseptic action. It seems to me 
that this opens a very wide and important field of thera- 
peutics. In the early stages of cholera, typhoid fever and 
dysentery, in cholera infantum and in cases of milk 
poisoning, it would seem that this method of therapeutic 
procedure should prove beneficial." 

Dr. Hedges, of Plainfield : " It has been my practice to 
use cold water, high up in the bowel, in cases of acute 



62 MEDICAL SOCIETY OF NEW JERSEY. 

intestinal indigestion in children. I have seen a tempera- 
ture of 105^ or 106^ F. come down to 99** after this use 
of cold water, and remain down for four or five hours. 
A repetition of the enteroclysm would again bring down 
the temperature, and it has been possible to hold the 
temperature within safe limits until other measures were 
successful in relieving the system of the poisons in the 
intestinal tract. I agree with Dr. Daland, that it is a 
most important adjuvant to treatment. I use as cold 
well water as can be obtained, and place ice in this." 

Dr. Benjamin, of Camden : " I have had ah experience 
with this treatment in but one case ; a case of intestinal 
hemorrhage from typhoid fever ulceration. The case 
was a very serious one and occurred at midnight. It was 
noticed by the nurse, who had been directed, on that 
particular day, to take the temperature frequently. 
About four o'clock the temperature suddenly fell three 
degrees. The injection of ice-water resulted in arresting 
the hemorrhage. I desire to ask Dr. Daland to what 
extent he has used antiseptics by this method, if at all, 
and what have been the results." 

Dr. P. C. Barker, of Morristown : " I have used the 
enteroclysms, and have been greatly gratified with the 
treatment in various conditions, especially in one condition 
which, I think, has not been mentioned, i, e. catarrhal 
jaundice. We all know how difficult these cases are to 
treat. I have treated a number of these cases with injec- 
tions of ice-water, for several days in succession, once 
daily, followed afterward by injections of very hot water. 
At one time, cold water was used in one part of the day 
and hot water at another time of the day. 

" With respect to the length of the tube, I would say 
that two feet is hardly long enough. I use a tube which 
is nearly four feet long, and in several large men I have 



MINUTES. 63. 

found it necessary to introduce it nearly its whole lengths 
Cold water, or even hot water, is very apt to excite con- 
tractions of the intestine, and I find by carrying the tube 
high up and allowing the fluid to flow very slowly at first,, 
much more can be introduced, and with much less dis- 
comfort. I have used antiseptics of various kinds. I 
have freely used i to 5,000 bichloride of mercury in many 
instances, in dysentery, and with great satisfaction. It. 
seems to me that the washing out of the large intestine 
is the point of greatest importance." 

Dr. Daland : *' I have not used antiseptics very largely 
for the reason mentioned by the last speaker, u e,, that ii> 
most cases the thorough washing out of the large intes-- 
tine, and sometimes of the small intestine also, has- 
seemed not to make it very important that antiseptics, 
should be used. Then, too, there is a constant fear on my 
part that if antiseptics are used in efficient quantities, that 
there will be a certain danger to the patient from absorp-- 
tion of a certain quantity of the antiseptic. As has been 
stated, a considerable quantity of the fluid is retained,, 
and is absorbed; hence, if there is any considerable 
quantity of an active antiseptic, it is evident that the 
patient is exposed to a certain danger. I have been- 
strongly impressed with what may be called the aseptic, 
properties of simple salt solution. I have used chlorine 
water and believe it to be useful. So far as cholera^ 
Asiatica is concerned, I would say that I regularly em-- 
ploy a three per cent, solution of tannic acid, as experi- 
ments have shown that the cholera bacillus fails to- 
develop in an acid medium, and a very, small quantity of 
tannic acid (half per cent.) is able to inhibit the growth, 
of this bacillus. It was the rejection<of this fluid by the 
mouth that first directed my attention to the fact that, 
the fluid of an enteroclysm enters, the small, intestine,. 



64 MEDICAL SOCIETY OF NEW JERSEY. 

and then, perhaps, by reversed peristalsis, is ejected from 
the stomach. The use of enteroclysm in cholera infantum 
I should have mentioned, for it has done much good. The 
use of this same agency in cholera morbus is also import- 
ant, and I have seen it do very much good in this condi- 
tion. I think I have answered Dr. Benjamin's questions 
in my paper. I have used a saturated solution of boric 
acid in a number of cases, and apparently with good 
results, although it must be recollected that the employ- 
ment of any antiseptic is an unusual occurrence with us. 

" In these cases, a very simple expedient will increase 
the probability of expelling all of the fluid injected, /. ^., 
vigorous movements on the part of the patient or a re- 
sort to abdominal massage. If, however, there is dilata- 
tion of the colon and atony of its wall, this may not be 
sufficient. 

** Regarding the use of enteroclysms in catarrhal 
jaundice, I can see how it might be very beneficial in 
many instances. In catarrhal jaundice we have a diminu- 
tion in the quantity of bile entering the intestines ; in some 
cases almost no bile enters the bowel. I know of no 
intestinal antiseptic which compares with three pints of 
bile secreted by a healthy liver, and therefore, when the 
normal supply of bile is cut off, the intestinal contents 
readily undergo putrefaction. This putrefaction is sug- 
gested to us by the remarkable fetor noted when we 
examine the alvine discharges. The poisonous material 
absorbed is ordinarily carried to the liver, thus establish- 
ing practically a vicious circle. For these reasons the use 
of enteroclysms in catarrhal jaundice should prove of 
great advantage. 

" Regarding the question of the size of the tube, I 
would say that I have no objection to increasing the 
tube to twice its present length, and it may be of advan- 



MINUTES. 65 

tage in certain cases. The essential point is to pass the 
sigmoid flexure. Injection into the rectum merely, is 
followed by a prompt contraction and ejection of the 
fluid. In an ordinary adult, the passage of the tube in 
for a distance of eight inches will place the tip of the 
tube beyond the sigmoid. If the tube be introduced 
sixteen inches, its tip should be, under ordinary circum- 
stances, in the neighborhood of the splenic flexure of the 
colon or in the transverse colon. I see no reason for the 
tube being passed further in any case, for, by the patient 
assuming a proper position, the fluid can be made, by 
gravity, to pass into the ascending colon and caecum. 
Then, by hydrostatic pressure, the competency of the 
ileo-caecal valve can be overcome. The method I recom- 
mend seems to me to greatly simplify the whole subject. 
I cannot refrain from speaking of the enormous impor- 
tance of using this same tube in what is called ' rectal 
alimentation.' It is not rectal feeding at all, for the 
rectum^has an entirely different function. It should be 
called colonic feeding, and it is into the colon, beyond 
the rectum, that the fluid should be introduced. When 
this is done, there is no difficulty in having the nutritive 
fluid retained.'* 

On motion of Dr. Chandler, the regular order of busi- 
ness was suspended, and the Society proceeded to the 
consideration of miscellaneous business. 

The resignations of Dr. V. M. D. Marcy, of Cape May, 
and of Dr. Andrus, of Middlesex, were read, and on 
motion, were accepted. 

Dr. T. Y. Sutphen offered the following resolution : 

Resolved^ That a committee of five be appointed by the chair, 
whose duty it shall be to take into consideration the abuse of charity 
in public institutions of the State, and the means for its curtailment, 
5 



(i6 MEDICAL SOCIETY OF NEW JERSEY. 

and that this committee shall report at the next annual meeting of 
the Society. 

Seconded by Dr. Chandler. 

Dr. L. F. Bishop said he came from a city, New York, in 
which this abuse had assumed outrageous proportions 
He was, therefore, very glad to see that this Society 
proposes to take up this important matter before it 
becomes an incurable disease. 

Dr. Charles P. Noble, of Philadelphia, said that he 
could also speak from personal experience, and he was 
glad that New Jersey was about to take up this matter. 
His own opinion was that this abuse of medical charity 
is largely the fault of the medical profession, and hence 
it is fortunate that New Jersey has not quite so many 
hospitals and dispensaries as some other parts of the 
country. It might be possible for her to keep down 
this abuse. 

The motion was then carried unanimously. 

Dr. W. J. Chandler presented the following preamble 
and resolution : 

Whereas, There exists in New Jersey no adequate legislative 
control over the pollution of the water supplies of the cities and towns 
throughout the State. 

Whereas, The pollution of streams, due to the discharge into 
them of sewage and to other sources of contamination, is increasing 
to an alarming extent along almost every water course in the State. 

Resolved, That the Medical Society of New Jersey recommends the 
enactment of a law which will effectually prevent the defilement of 
the water sheds and the streams and lakes which are now in use, or 
which may hereafter become necessary for use for supplying water 
for potable purposes. 

Seconded and carried unanimously. 
Drs. Mitchell, Johnson and John Taylor, a committee 
from Monmouth County Society, presented the following: 



MINUTES. 67 

WHlLREASt About twenty-eight per cent, of the population of the 
State of New Jersey are within the age period 5 to 20, and a large 
proportion of these persons are pupils in the public schools. 

Whereas, The laws compel parents to send their children to either 
public or private schools, and it therefore becomes the moral duty of 
the State to inquire into the healthfulness of school buildings and 
premises, and to prevent these institutions from becoming centres for 
the distribution of the germs of infectious diseases. 

Whereas, The public school system is provided by the State for 
the purpose of making good citizens, and it would be inconsistent 
to educate the minds of the rising generation and fail to care for their 
health and life. 

Whereas, Measures for the early detection of infected pupils ; for 
the exclusion of those who are affected by the dangerous communic- 
able diseases, and for safe guarding the strength and health of 
the children should be promptly, faithfully and skillfully employed ; 
therefore be it 

Resolved, That a committee be appointed to secure such legislation 
as may be necessary to establish and maintain suitable and efficient 
hygienic and medical supervision and inspection of the public schools. 

Seconded and carried. 

Dr. Elmer moved that hereafter the Recording Secre- 
tary shall arrange for the registration of all delegates 
in attendance at the annual meeting. Seconded, and 
carried. 

The President presented the report of the Committee 
on Fellows' Prize Essay (see Appendix), and announced 
that the prize had been awarded to Dr. Frederick 
Randolph Bailey, of Elizabeth, for an essay entitled, 
"The New Histology and Pathology of the Central 
Nervous System." 

Dr. Bailey arose and thanked the Society. 

The President replied that this was a source of con- 
gratulation for the Society, as for a number of years the 
prize was not awarded, because the papers presented were 
not considered of sufficient merit, until last year, when 



68 MEDICAL SOCIETY OF NEW JERSEY. 

the prize was awarded to Dr. Bayles, and now again to 
Dr. Bailey this year. 

Dr. H. W. Elmer offered the following resolution: 

Resolved^ That should district ' societies desire reports of special 
celebrations published in the Transactions, these reports shall be pub- 
lished, provided the district society furnishing such report bears half 
the additional expense incurred. 

Seconded by Dr. Chandler. 

Dr. P. C. Barker moved to amend this resolution, by 
requiring that the whole expense shall be borne by the 
district society. Seconded. 

Dr. Hand remarked that in view of the fact that 
lengthy reports of this kind had just been admitted with- 
out any expense, it would seem better for the State Society 
to bear half the expense for the present, at least. 

Dr. John C. Johnson, of Blairstown, said that this 
practice of publishing reports from the district societies 
had been initiated a long time ago by Dr. Wickes, and 
had been encouraged because it swelled the volume of 
Transactions. 

Dr. Newton thought it was well to curtail the printing of 
proceedings, if possible. He suggested that the matter 
might be referred to a committee for further report. 

The amendment was voted down and the original 
motion was carried unanimously. 

On motion, the Society adjourned at 6.05 p. m. 



EVENING SESSION. 

The meeting was again called to order by the Presi- 
dent at 8.30 p. m. 

Dr. P. C. Barker, of Morristown, moved the adoption 
of the following resolutions : 



MINUTES. 69 

Whereas, Preventive medicine demands the complete isolation and 
quarantine of cises of contagious disease ; and 

Whereas, It is often impossible to separate such cases in the 
homes of the poor; therefore, be it 

Resolved, That the Medical Society of New Jersey hereby most 
strongly recommends the erection of a hospital for contagious dis- 
eases in every city and incorporated town in the State ; 

Resolved, That in this way, and in this way only, can the multipli- 
cation and spread of contagious diseases be prevented. 

In support of these resolutions, Dr. Barker said that 
twenty-five years ago he began the advocacy of the 
erection of a hospital for contagious diseases in Morris- 
town. Nothing came of it for a number of years, but 
finally circumstances conspired in such a way that five 
years ago such a building was planned and e|^ected. It 
has a central administration building, with kitchen and 
nurses* rooms. On either side and behind are wards, 
separated from the main building by corridors. Each 
corridor has its separate entrance, and two closets, one of 
them for the clothing of the physician who comes to 
visit a patient — his ordinary street clothing — and the 
other for the gowns and caps for use in the ward. On 
the left hand side is a ward for scarlatina, consisting of 
two rooms, one for each sex. There is a private room 
for taking cases out of other houses than those of the 
poor. In the rear are two scarlatinal wards for the two 
sexes. On the right side is the ward called the *' suspect 
ward,*' in which c^ses of suspicious character are taken 
for development. It would also be, in case of necessity, 
a small-pox ward. The angles and corners and lines are 
rounded off so as to facilitate cleaning. The floors are 
made of carefully selected maple. The walls are of 
adamant, which is very impervious to moisture, and 
capable of withstanding rough usage. The system of ven- 



70 MEDICAL SOCIETY OF NEW JERSEY. 

tilation is easily managed, and works admirably. The 
kitchen and heating apparatus in the basement are con- 
nected with a large ventilating flue, which is kept heated 
in summer by the kitchen range, and in winter, by the 
the combined heat of the range and hot water apparatus. 
On one occasion the hospital had been very much over- 
crowded in the scarlatinal ward, but there was no time 
during that period when there did not seem to be plenty 
of air. It is an expensive system of ventilation because 
of the large quantity of cold air coming in from the 
outside constantly, necessitating a large expendi- 
ture of fuel to keep the rooms up to the proper 
temperature. 

This hospital has been in operation five years. Six 
months ago the one hundredth case of scarlatina was 
admitted. Two years ago a small child came to the 
town with its parents for a visit. Nine or ten days 
afterward the child developed scarlatina. Contrary to 
the advice of the physician the child went back to 
school too soon, and within ten days thirty or forty of 
the forty-three scholars exposed developed scarlatina. 
Most of them were sent to the hospital. There were 
altogether 85 cases before the epidemic was stamped 
out. If it had not been for the complete isolation of 
the sick ones as the disease developed, it was reasonable 
to suppose that there would have been very many more 
cases and more or less resulting mortality. Out of the 

too cases treated at the hospital, there <had been but two 

* 

deaths. Those two children came from a crowded cellar 
and were half starved at the time of their admission. 
They had no reserve force, and, as one of the character- 
istics of that epidemic was severe vomiting, this rapidly 
produced exhaustion. One of the children died on the 
fifteenth day suddenly of heart failure ; the other died 



MINUTES. 71 

on the thirteenth day in a convulsion. There was no 
albuminuria, and the child apparently died purely of 
inanition. 

With the exception of four cases treated privately by 
other attending physicians, there were no complications 
of any kind. The urine was examined daily, or at inter, 
vals of two or three days, yet there was not a single case 
of albuminuria recorded. Nor was there any middle ear 
disease or rheumatism. The private cases all developed 
some complication. These facts were mentioned to show 
what could be done by proper hospital care. A long 
time ago. Dr. Barker said, he became convinced of the 
importance of keeping scarlatinal patients in bed for a 
considerable time on milk diet, and this, he thought, 
explained the immunity of his cases from albuminuria 
and other complications. Last year they had been 
threatened with an epidemic of diphtheria. Out of 23 
cases coming to the hospital, three were lost. His claim 
was that the good results were due, not so much to the 
kind of treatment, as to the system and discipline. For 
instance, the noses and throats of the children were 
sprayed out every fifteen minutes, night and day, which 
could not have been done in private practice. The people 
of Morristown were now anxious to send their- children 
to the hospital. 

The resolution was then adopted unanimously. 

Dr. C. Shepherd, of Trenton, offered the following 
resolution : 

Resotved, That the reports of the progress of medicine made under 
the Standing Committee, be limited hereafter, in their presentations, 
to fifteen minutes, but they may be published in extenso in the Trans- 
actions ; also that they be strictly reports of progress in their respec- 
tive departments. 

Seconded, and carried unanimously. 



72 MEDICAL SOCIETY OF NEW JERSEY. 

The remainder of the evening was devoted to addresses 
and scientific essays, and the discussion of the same. 
The following essays were read ; 

Essay by J. C. Applegate, M.D., Bridgeton. ** Regres- 
sion vs. Progression ; Viewing the General Practitioner 
from a Scientific Standpoint." (See Appendix.) 

Essay by P.A.Harris, M.D., Paterson. "The Dangers 
of Certain Faulty Impressions regarding the Menopause." 
(See Appendix.) 

Dr. Charles P. Noble was invited to open the discussion. 

Dr. Noble : " I take great pleasure in discussing this 
paper because the subject is one of very great practical 
importance. The old theory that the menopause is 
attended by numerous symptoms, seems to be very hard 
to get rid of. Most of the profession have gotten rid of 
this notion, but not all. The laity still hold fast to this 
idea which they learned, of course, originally from the 
medical profession. It is therefore important that the 
profession should educate the laity over again in the 
new doctrines regarding the menopause. The physiologi- 
cal menopause is attended with very few symptoms, and 
those symptoms are referable to the nervous system. 
The hot flushes and the sweatings are of course, common, 
and occasionally we have such mental derangements as 
melancholia. Aside from these, I believe there is no 
further disturbance at the menopause than there is at the 
onset of puberty — indeed, we should not expect any 
greater disturbance at the cessation than at the onset of 
sexual life. The most unfortunate result of this wrong 
notion about the menopause is, that cancer is often over- 
looked or neglected until it is beyond relief by operation. 
I have seen cancer of the cervix spread down the vagina 
almost to the vulva without any symptoms whatever 
indicative of its presence. On the other hand, it is very 



MINUTES. 73 

common to find that there have been leucorrhoeal or 
bloody discharges for a year or more before any examin- 
ation has been made. This is, of course, the fault of 
the patient in not having consulted the physician, or of 
the physician in not having more promptly examined 
her. If the discharges are due either to endometritis or 
fibroid tumor, a little delay is not very important, except 
for the added suffering to the patient. The danger of 
delay applies particularly to cancer of the cervix, for 
cancer of the body runs a very slow course. All of the 
cases of this latter variety that I have seen have 
remained free from recurrence after its removal. The 
prognosis, therefore, in cancer of the body of the uterus 
is very good, even though the symptoms may have 
lasted as long as two or three years. The family physic- 
ian, therefore, must educate his patients to the belief 
that the menopause should not be accompanied by irreg- 
ular discharges, and that if they have irregular or hemor- 
rhagic discharges, it is not because of the menopause, 
but because they have some serious uterine disease." 

Dr. Walter B. Johnson : " I think the thanks of the 
Society are due to our friend. Dr. Harris, for this paper, 
which has entered into a realm of thought hitherto 
unplowed, or at least, so imperfectly plowed that satis- 
factory conclusions have not been reached. I feel also 
like expressing the pleasure that the Passaic County 
'Society has in having one of its members present such a 
paper. I have been directed by many of Dr. Harris* 
friends to present to him a token of esteem, and I 
now take pleasure in doing so.'* (Hands a bouquet to 
Dr. Harris). 

Dr. Balleray, of Paterson : ** I merely rise to express 
tny appreciation of the merits of the paper presented by 
Dr. Harris. I consider this subject so important that I 



74 MEDICAL SOCIETY OF NEW JERSEY. 

« 

had threatened to write a paper upon it myself, but Dr. 
Harris has * taken the wind out of my sails * by writing: 
a paper far better than any I could have written. 

" The menopause is undoubtedly a very critical period 
in a woman's life, but, as has been said by the previous 
speakers, a very great portion of the danger is due to 
the ignorance of the laity and of a portion of the profes-^ 
sion. Even at the present day, the general impression 
prevails that all sorts of complications are to be expected 
at that time of life, and as a matter of course, and for 
that reason, lesions which should receive prompt treat- 
ment often receive no treatment at all until they have 
passed the proper stage for successful treatment. Cancer 
is, of course, most to be dreaded at this time of life, and it 
is very commonly overlooked until it has become inoper- 
able. It is probably a fact that at least seventy per cent, 
of the cases referred to the operating gynecologist have 
passed the operative stage. If the time ever comes that 
the symptoms are properly interpreted and radical treat- 
ment is adopted, I believe the mortality from cancer of 
the uterus will be very much diminished. As the matter 
stands at present, a woman about the age of forty,, 
begins to have irregular sanious discharges, and consults 
some elderly dame instead of her physician. This 
worthy person quiets her apprehension for the time, and 
when she does finally consult her physician he frequently 
makes no examination at all, or makes a superficial one^ 
and fails to recognize the true nature of the disease. 
When she calls again, six months or a year later, it is 
found that malignant disease has invaded perhaps both 
the cervix and the vaginal wall. If the case is then 
referred to the surgeon, even though he may succeed in 
removing the uterus, the lymphatic involvement is such 
that the patient dies before long. It is most unfortunate: 



MINUTES. 75 

that the physician, often instead of blaming himself for 
not having given the case proper attention, flatters him- 
self that he has done his whole duty, and has been ' con- 
servative.* This sort of conservatism should cease; the 
proper name for that sort of conservatism is 'criminal 
neglect.' 

" However, I do not wish to bear down upon the 
family physician and general practitioner ; on the con- 
trary, I cannot help feeling that the general practitioners 
are * the salt of the earth.* They do more faithful work 
without compensation, except that which comes from 
love from their fellow-men, than any other class in the 
community. Like the poor, they are always with us. 
They superintend our advent into this world, and some 
people say that they sometimes hasten our exit. We 
should be thankful to them, and should not find too much 
fault if they occasionally overlook a lesion with which 
they are not entirely familiar. 

" We might reasonably ask, whether or not the gyne- 
cologists are entirely free from blame. May not their 
conduct have something to do with the delay of 
the general practitioner in referring cases to them? 
Gynecologists are, indeed, occasionally at least, active 
transgressors; their sins are not sins of omission, but of 
commission. The general practitioner believes that the 
gynecologist is prone to operate when it is not absolutely 
necessary, and this causes him to hesitate to refer cases 
until it is too late to do much good. I have myself seen 
uteri removed, which afterwards showed no evidence of 
cancer, either to the ordinary person or to the expert 
pathologist. These mistakes shake the confidence of 
the general practitioner. If the gynecologist is faithful 
in his part of the work, I think he will find that the gen- 
eral practitioner will not be delinquent in his duty. I 



76 MEDICAL SOCIETY OF NEW JERSEY. 

think the general practioner might say truthfully to the 
gynecologist : * Thou hypocrite, first cast the beam out 
of thine own eye, then canst thou see clearly to cast out 
the mote which is in thy brother's eye.* " 

Dr. Harris : ** I have nothing very much to say in closing 
this discussion, more than to thank Dr. Noble for the 
stand he takes. I thank him for supporting me. I think 
that we have no right to blame the family practitioner ; I 
think we have no right to blame him for his mistakes; 
he pays us a compliment when he asks us in consulta- 
tion ; we have no right to offend him by intimating in 
any way that he did not fully understand the case, or 
appreciate its dangers. He comes to the consulting 
gynecologist for knowledge, or confirmation of his views. 
We must stand by the family physician. Those who 
lead in ideas are accountable for what prevails Dr. 
Noble has touched upon this when he said that the 
opinion of the laity represented what they had been 
taught at some time by the medical profession. All 
operators will occasionally operate upon cases in which 
the subsequent events show that the operation was not 
necessary. 1 have removed uteri which might have been 
left in, but I also believe that gynecologists are practicing 
their art to the best of their knowledge and ability. 

"Regarding the token presented to me from my 
friends in Paterson, I would say that I appreciate the 
compliment very much, and I wish to thank them most 
heartily." 

Essay by S. A. Twinch, M.D., Newark. "The Early 
Diagnosis and Treatment of Potts' Disease," illustrated 
with dissolving views. (See Appendix.) 

Dr. J. G. Edwards, of Clayton: "I think a word of 
experience in the suffering of such patients may be of 



MINUTES. 77 

interest. At birth I weighed thirteen pounds. My 
family history is excellent, and there is no tubercular 
trouble of any kind in the family. Fn my early infancy, 
a sister let me fall, and as a result, I developed the 
disease of the spine with which I am now afflicted. All 
sorts of methods of treatment were tried, without suc- 
cess, but finally nature gave me relief. I have studied 
this disease especially because of my sympathy for those 
afflicted with it, and I can say from experience that the 
plaster of Paris jacket is the appliance for this disease. 
Dr. Say re has been a messenger from God for those suf- 
fering from Pott's disease. I have seen wonderful 
benefit from the use of the plaster jacket by this eminent 
surgeon. I know from personal experience that a 
properly applied plaster of Paris jacket affords wonderful 
relief. The essential in the treatment is absolute rest. 
Pott's disease can be detected in its earliest stage, and I 
implore you not to neglect the first indications of this 
dread disease. In the early stage the patient cannot 
stoop far and bend the spine ; it is kept rigid, just as the 
neck is in torticollis." 

Dr. Corwin, of Newark : " I wish to express the pleas- 
ure that I have felt in listening to this paper. We, in 
Newark, feel great pride in the work of Dr. Twinch. 
We are especially pleased to hear him tonight, because 
he has lately passed through a severe illness." 

Dr. I. W. Condict, of Dover : " In using the plaster of 
Paris it must be remembered that it has a tendency to 
crumble and soil the bed. I have used with much satis- 
faction, the silicate of soda, as a substitute for the plaster 
of Paris. It will not crumble and the weight of the 
jacket can be very greatly reduced. I applied such a 
jacket to a child with Pott's disease. He wore it 
between one and two years. That jacket weighed only 



78 MEDICAL SOCIETY OF NEW JERSEY. 

fourteen ounces, whereas a plaster of Paris jacket would 
have weighed as much again. In applying it, the child 
is suspended and the plaster of Paris jacket is applied. 
This is used as a mould on which the silicate of soda 
jacket is made." 

Dr. Chandler moved that a vote of thanks be extended 
to Drs. Applegate, Harris and Twinch, the essayists, for 
their interesting and instructive addresses. It was 
unanimously carried. 

Dr. Chandler made partial report of Committee on 
Credentials. They had examined the credentials of Dr. T. 
N. McLean, of Union, Dr. Addison W. Taylor, of Burling- 
ton, and Dr. Edward B. Dana, of Middlesex, had found 
them correct in form, and recommended that they be 
elected permanent delegates. 

Dr. Young moved that the report be accepted. 
Seconded, and carried unanimously. 

Dr. Fisher moved that the Secretary cast a separate 
ballot for each of the names read. There being no 
objection, the Secretary cast the ballot as instructed by 
the Society, and they were declared duly elected perma- 
nent delegates. 

On motion, the Society adjourned at 10.15 p. m. 

THIRD DAY— THURSDAY JUNE 30th. 

The meeting was called to order, by the President, at 
9.30 a. m. 

Action on amendments to the By-Laws, Chapter i, 
Section 4 —Dr. Chandler moved that all consideration and 
action on these amendments be deferred to the next 
annual meeting, and that the whole matter be referred to 
the Committee on Permanent Delegates, previously ap- 
pointed ; f uther, that the said Committee be instructed to 



MINUTES. 79 

revise all by-laws relating to the permanent delegates and 
report at next meeting, and that this be considered as 
sufficient notice to take action thereon at that time. 
Seconded, and carried unanimously. 

Dr. Mitchell moved that the name of Dr. David C. 
English be added to this Committee. Seconded, and 
•carried unanimously. 

Dr. John C. McCoy presented " Cases of Appendicitis, 
with Specimens." (See Appendix). 

**A Case of Nephrectomy." — Dr. McCoy also pre- 
sented a kidney removed four weeks previously. Six 
weeks ago she had been operated upon by Dr. H. A. 
Kelly, of Baltimore, for a large insterstitial fibroid. At 
that time the right ureter was found to be about the size 
of the thumb, and the kidney, when palpated through 
the abdomen, exhibited distinct fluctuation. The con- 
dition of the patient was such that Dr. Kelly did not 
feel like attacking the kidney at that time. She made a 
good recovery from the hysterectomy. Just prior to the 
incision for nephrectomy, Dr. McCoy said, he catheter- 
ized the ureters, and obtained pus from the affected side, 
and perfectly normal urine from the other side. A lum- 
bar incision was made, and the ureter was ligated close 
to the bladder, and the stump of the ureter was stitched 
into the iliac muscle. The patient made an uneventful 
recovery, and left the hospital two weeks after the 
nephrectomy. 

A Portable Operating Table was exhibited by Dr. Phi- 
lander A. Harris, of Paterson : *' I have here an operating 
table which I have brought at the request of Dr. Johnson. 
The table has not been put on the market as yet, al- 
though several have been made for the use of friends as 
well as for myself. The object of the table is to afford a 
portable table which is sufficiently strong for use in private 



80 MEDICAL SOCIETY OF NEW JERSEY. 

houses, and which will also give the Trendelenburg posi- 
tion. This position is not always required, but when it is, 
it is needed badly. As you see, the table folds up and 
can be carried in a rather large canvass case. The table 
is built of wood, brass, aluminum and bicycle tubing. 
By a telescopic device, the etherizer can lower the table 
and control easily and perfectly its height. In doing a 
laparotomy I usually bandage the patient's legs to the 
foot-piece. The table is very evenly balanced, and at a 
a point which is rather unusual for operating tables. As 
consequence of this peculiar feature the level of the 
pelvis remains the same whether the patient is in the 
horizontal or in the Trendelenburg position." 

Dr. Harris exhibited New Perforating Forceps for Es- 
tablishing Vaginal Drainage. '*I have here an instrument 
which I have devised. A few years ago those doing 
pelvic work were in the habit of putting in from above, 
what they call a ' drain.' Why it was called a drain, 
working as it did against gravity, is rather difficult to 
understand, unless it was that we could suck out the 
fluid through it if we desired to do so. Laparotomists 
have now settled down to vaginal drainage when drain- 
age of the pelvis is required. It is rather difficult and 
time-consuming to affect an opening into the retro- 
uterine peritoneal pocket during operation, without soil- 
ing the hands of the operator too much. It therefore 
occurred to me that if I took a Cleveland's ligature 
carrier, like the one in my hand, and placed it behind the 
cervix and tore a hole with it, the assistant could then 
pass in from above the aseptic gauze, and it could be 
easily drawn down into the vagina. The device seems 
to be admirably adapted for this purpose." 

Dr. W. B. Johnson : ** This presentation of patholo- 
gical specimens and new instruments is a new order of 



J 



MINUTES. 8l 

business which has been established this year. I think it 
will prove instructive and advantageous to us. The 
beautiful manner in which the specimens presented have 
been prepared, make it very easy for us to understand 
the location and character of the perforations. The 
Doctor has photographs of these specimens, and I be- 
lieve accompanying his report he should make some 
arrangement by which they may appear with the pub- 
lished paper." 

Dr. Johnson then moved that the reports be received 
and handed to the Standing Committee for publication, 
and that these gentlemen receive the thanks of the 
Society. Seconded and carried unanimously. 

The President announced, with regret, that two actions 
taken by the Society at Tuesday afternoon's session, were 
in contravention of the by-laws of the Society, and there- 
fore were unconstitutional. The first, related to the 
election of Dr. Samuel H. Pennington as an honorary 
member, by a rising vote. The by-laws required a two- 
thirds vote by ballot. The exalted character and distin- 
guished services rendered to this Society by the vener- 
able and beloved ex-president, as well as the welfare of 
the Society, require that there be no question as to the 
validity of the election, and no member, he said, would 
more strenuously object to irregular procedure than Dr. 
Pennington himself. It was therefore recommended that 
a ballot be taken at the present time. The second 
matter was the receipt of two certificates from delegates 
which were not in conformity with the by-laws. It was 
accordingly recommended that their election be recon- 
sidered, and that action on their election be deferred 
until next year, when the prescribed certificate shall be 
in the Secretary's possession. 

Dr. Chambers moved that a ballot be taken on the 



82 MEDICAL SOCIETY OF NEW JERSEY. 

election of Dr. Samuel H. Pennington. Drs. Exton and 
Chambers were appointed tellers, and Dr. Pennington' 
was declared to be unanimously and constitutionally- 
elected an honorary member. 

Dr. Shephard moved that action on the two permanent 
delegates be now reconsidered. Seconded, and carried 
unanimously. 

Dr. W. B. Johnson moved that these names be referred 
to the Committee on Permanent Delegates. Seconded, 
and carried unanimously. 

Dr. Elmer said that the volume of Transactions 
always appeared very late, and this was not due to- 
any fault of the printer or of the Standing Com- 
mittee, but to the delay resulting from revision of 
manuscripts by their authors. It had been decided 
this year to require all proof to be returned within 
one week, and notice to that effect would be sent out 
with the proof. 

The President announced the appointment of the fol- 
lowing to serve on the Committee on Abuse of Medical 
Charity : Dr. T. Y. Sutphen, of Newark^ chairman ; Dr. 
George H. Balleray, of Paterson; Dr. T. V. Cantwell, of 
Trenton ; Dr. F. D. Gray, of Jersey City, and Dr. J. S. 
Bayer, of Camden. 

Some pathological specimens and new instruments 
were then presented. 

The President then introduced the representative of 
the N. J. Pharmaceutical Association, Mr. Williams. 

Mr. Williams : '* I am not like a politician who has a 
little memorandum in his pocket, but I am called here in 
place of a brother who, because of sickness in his family,, 
is not able to be present. The New Jersey Pharma- 
ceutical Association is one of the oldest associations in 
the United States. We would like to stimulate a pro- 



MINUTES. 83 

fessional feeling between the pharnnacists and the physi- 
cians. Ninety per cent, of the pharnnacists of the present 
day are professional men. They are well educated ; their 
course comprises three years of study, and they must 
pass rigid examinations. Of course, roguery sneaks into 
the profession of pharmacy, as into others ; nevertheless, 
ninety per cent, of the pharmacists are all right. We 
wish to show our respect for the medical profession by 
sending our representative here. I am very much obliged 
to you for your attention ; I hope you have had a good 
meeting, and if you come again to Asbury Park, we shall 
try to make it pleasant for you." 

Report of Committee on Nominations. — Dr. L. L. 
Hand presented the following report : 

The nominating Committee met at Hotel Columbia, with Dr. W. B. 
Johnson as chairman and Dr. L. L. Hand secretary. VVe forthwith 
present the following nominations : 

President — Dr. C. R. P. Fisher, Bound Brook, Somerset County. 

First Vice-President — Dr. Luther M. Halsey, Williamstown, Glou- 
cester County. 

Second Vice-President — Dr. William Pierson, Orange, Essex 
County. 

Third Vice-President — Dr. John D. McGill, Jersey City, Hudson 
County. 

Corresponding Secretary — Dr. E. L. B. Godfrey, Camden, Camden 
County. 

Recording Secretary — Dr. W. J. Chandler, South Orange, Essex 
County. 

Treasurer — Dr. Archibald Mercer. Newark, Essex County. 

Members of Standing Committee — Dr. Dowling Benjamin, Camden, 
Camden County ; Dr. E. W. Hedges, Plainfield, Union County. 

Place of Next Meeting — Lake Hopatcong (Country Club.) 

Committee of Arrangement — Dr. A. E. Carpenter, chairman. Boon- 
ton, Morris County ; Dr. W. B. Johnson, Paterson, Passaic County ; 
Dr. John Nevin, Jersey City. Hudson County ; Dr. L. Farrow. Middle 
Valley, Morris County; Dr. George A. Van Wagenen, Newark, 
Essex County. 



84 MEDICAL SOCIETY OF NEW JERSEY. 

Committee on Business — Dr. W. B. Johnson, Paterson, Passaic 
County; Dr. George Van Wagenen, Newark, Essex County; Dr. E. 
Hollingshead, Pemberton, Burlington County ; Dr. W. Updyke Scl- 
over, Rahway, Union County; Dr. T. R. Chambers, Jersey City, 
Hudson County. 

Prize Essay Committee — Dr. Philander A. Harris, Paterson, Passaic 
County. 

Committee on Honorary Membership — Dr. H. Genet Taylor, Cam- 
den, Camden County. 

Delegates to American Medical AssocidJion — Dr. B. A. Wadding- 
ton, Salem, Salem County ; Dr. T. J. Smith, Bridgeton, Cumberland 
County ; Dr. Henry Mitchell, Asbury Park. Monmouth County ; Dr. 
Edward J. Ill, Newark, Essex County ; Dr. S. A. Heifer, Hoboken, 
Hudson County. 

Delegates to Massachusetts Medical Society — Dr. T. R. Chambers, 
Jersey City, Hudson County ; Dr. J. A. Exton, Arlington, Hudson 
County. 

Delegates to Rhode Island Medical Society — Dr. M. Lampson, 
Jersey City, Hudson County ; Dr. L. L. Hand, Leesburg, Cumberland 
County. 

Delegates to Connecticut Medical Society— \^x , H. G. Wagoner, 
Somerville, Somerset County ; Dr. John G. Ryerson, Boonton, Morris 
County. 

Delegates to New Hampshire Medical Society — Dr. W. E. Berkaw, 
Annandale, Hunterdon County ; Dr. W. P. Watson, Jersey City, 
Hudson County. 

Delegates to Pennsylvania Medical Society — Dr. W. H. Carpenter, 
Salem, Salem County ; Dr. Geo. L. Romine, Lambertville, Hunterdon 
County. 

Delegates to New York Medical Society— T>r. John Nevin, Jersey 
City, Hudson County ; Dr. Edward Staehlin, Newark, Essex County ; 
Dr. I. S. Long, Freehold, Monmouth County ; Dr. E. B. Silvers, Rah- 
way, Union County; Dr. Charles Young, Newark, Essex County. 

Delegates to Maryland Medical Society — Dr. B. D. Evans, Morris 
Plains, Morris County ; Dr. D. Benjamin, Camden, Camden County. 

Delegates to American Pharmaceutical Association — Dr. H. L. 
Coit, Newark, Essex County; Dr. W. K. Newton, Paterson, Passaic 
County. 

Delegates to Mississippi Valley Medical Association — Dr. E. Stites» 



MINUTES. 85 

Bridgeton, Cumberland County; Dr. W. P. Watson, Jersey City, 
Hudson County. 

Above respectfully submitted, 

WALTER B. JOHNSON, Chairman, 
L. L. HAND, Secretary, 

Dr. Chambers moved that the report be received. 
Seconded, and carried unanimously. 

Dr. W. B. Johnson moved that the words "Country 
Club " be stricken out, as the consent of the club has not 
yet been obtained. Seconded and carried. 

Dr. Chambers moved that the Society proceed to 
the election of President. Seconded, and carried. 

Dr. Chambers moved that the Secretary cast the ballot 
for Dr. Fisher. Seconded, and carried unanimously, and 
Dr. Fisher was declared to have been elected President. 

Dr. Chambers moved that the Secretary cast a ballot 
for Dr. Halsey as First Vice-President. He was declared 
elected. 

On motion, the Secretary cast the ballot for Dr. Pier- 
son as Second Vice-President, and he was declared 
elected. 

On motion, the Secretary cast the ballot for Dr. John 
D. McGill for Third Vice-President, and he was declared 
duly elected. 

On motion, the Secretary cast the ballot for Dr. E. L. 
B. Godfrey, as Corresponding Secretary, and he was 
declared elected. 

On motion, the President cast a ballot for Dr. W. J. 
Chandler, as Recording Secretary, and he was declared 
elected. 

On motion, the Secretary cast the ballot for Dr. Archi- 
bald Mercer, as Treasurer, and he was declared elected. 

On motion, the Secretary cast a ballot for Drs. Ben- 
jamin and Hedges for the Standing Committee, and tbey 
were declared elected. 



86 MEDICAL SOCIETY OF NEW JERSEY. 

Dr. H. W. Elmer said that the Society had met 
previously at Lake Hopatcong, and his recollection 
was that it was difficult of access. He understood 
that there was considerable objection to this selection 
and that it was doubtful if proper accommodations could 
be obtained there. 

He therefore moved, that if the proper accommoda- 
tions could not be obtained at Lake Hopatcong, Lake- 
wood should be selected as the next place of meeting. 
Seconded. As an amendment, it was moved that Lake- 
wood be made the place of meeting. Seconded, and lost. 

The original motion was then put and lost. 

Dr. Reading moved that Deal Beach be the next place 
of meeting. This was carried. 

Dr. W. B. Johnson moved that, in view of the change 
in the place of meeting, a new Committee of Arrange- 
ments be selected. Seconded, and carried unanimously. 

Dr. L. L. Hand moved that the Asbury Park Com- 
mittee of the present year be appointed. Seconded, and 
carried unanimously. 

The President then declared the Committee of Arrange- 
ments to be constituted as follows: Dr. Henry Mitchell, 
of Asbury Park, Chairman ; Dr. D. Mc.L. Forman, of 
Freehold ; Dr. D. A. Currie, of Englewood, and Dr. 
George E. Reading, of Woodbury. 

Dr. Shepard moved that the Committee of Arrange- 
ments be given absolute authority to select a place in the 
vicinity, if it is found impracticable to hold the meeting 
at Deal Beach. Seconded, and carried unanimously. 

Dr. Reading moved that the meeting continue for three 
days: Tuesday, Wednesday and Thursday of the week 
in June selected for the meeting. Seconded, and carried. 

The members of the Fellows* Prize Committee were 
then formally and unanimously elected as follows : David 



MINUTES. 87 

C English, M.D., Chairman, Dr. Charles J. Kipp, Dr. 
P. A. Harris. 

On motion of Dr. Reading, the Secretary cast a 
ballot for the list of delegates as read, and they were 
declared duly elected. 

Dr. Reading presented the report of the Rush Monu- 
ment Committee. He said that the plan of voluntary 
contributions had dismally failed, and consequently the 
•Committee had decided that the Society must do its part 
as a society, or else they must say that they can do 
nothing. The individual plan had completely failed. 
{See Appendix.) The Committee recommended that 
this Society appropriate the sum of five hundred dollars 
to the Rush Monument Fund out of the funds of the 
Society, half to be paid this year, and the balance next 
year. 

The President said that the resolution was unconstitu- 
tional, as it involved a special expenditure of money. 
{By-Laws, Art. II, Sec. 6.) 

On motion, the report of the Committee was received. 

Dr. Reading moved that the recommendation of the 
Committee be not concurred in, in view of its apparent 
unconstitutionality. 

After some discussion. Dr. Shephard moved, as an 
amendment, that this matter be referred to the district 
-county societies, and that each county society be requested, 
as a society, to make an appropriation for this fund, and 
that the amount so contributed be sent to the Treasurer 
of the State Society. Seconded, and carried unanimously. 

Dr. A. W. Taylor, of Burlington, made the following 
remarks : 

Mr. President : As a new member, I have noticed a lack of par- 
ticipation in the discussions by the members outside the vicinity of 
the larger towns and cities in our own and adjacent States, of the 



88 MEDICAL SOCIETY OF NEW JERSEY. 

various papers so ably presented by the essayists of this meeting. It 
has seemed to me that our country practitioners might be more drawn 
into these discussions if some of their number could be persuaded to 
present papers or reports at the annual meeting of this Socieiy. They 
would probably be able, occasionally, to present some new ideas if 
not valuable ones, and certainly would be able to provoke or induce 
discussion upon points on which they needed information or instruction. 
I think, too, that making the rural physician an active participant in 
the meeting would tend much to increase his interest in this and other 
State health organizations It would also bring an increased interest 
in and attendance upon the meetings of the State Society on the part 
of the members of the suburban District Societies. As a means to- 
that end I would offer the following : 

Resolved, That the Corresponding Secretary be directed to invite 
each of the District Medical Societies to select, at their next meeting, 
one of their members to present a paper on -some medical or surgical 
subject for discussion at the next annual meeting of the State Medical 
Society. These selected men shall forward the title of their paper to 
the Secretary on or before February ist next preceding the meeting of 
the State Society. The Business Committee shall select from these 
titles such as they may deem sufficient in number and best adapted ta 
accomplish the purpose intended, viz., increasing the interest and 
attendance of delegates and members of the various District Societies 
upon the annual State meeting. 

This shall be done annually hereafter, and that no Society shall be 
represented a second time in this manner of selected essayists until 
all the District Societies shall have been thus represented. This 
resolution shall not prevent nor in any way interfere with the present- 
ation of such other selected, appointed or voluntary papers, essays or 
reports which the Business Committee may deem proper. 

Dr. Fisher said that the object sought to be accomp- 
lished by the resolution was a most desirable one, but if 
every one of the twenty- one counties should send in the 
name of an essayist for the next meeting, then the Busi- 
ness Committee must either give twenty-one papers, or 
they must seriously offend somebody whose work is re- 
jected. 

Dr. H. W. Elmer said he would endorse this resolution, 
except the statement that " it should be understood that 
this is to be done annually hereafter, and that no one 
shall be selected a second time until all of the district 



MINUTES. 8^ 

societies shall have been heard from." If one refused, it 
would block the whole arrangement. 

It was then moved, as an amendment, that the Corres- 
ponding Secretary each year indicate to those societies 
whose members have not presented papers within three 
years, this fact, and suggest that papers be handed in from, 
them, and that the Business Committee use its discretioa 
in selecting the papers presented. 

Dr. John C. Johnson said that the district societies 
generally decided whether a paper is worthy to be sent in 
to the State Society. 

Dr. Mitchell said that he thought, all appreciated the 
purpose of the mover of the resolution, and that all the 
members desired some arrangement which would properly 
apportion the literary work throughout the State ; never- 
theless, it did not seem that the matter could be settled 
at the present time satisfactorily. 

He moved that the matter be referred to a special com- 
mittee of three, to report at the next annual meetings 
Seconded, and carried unanimously. 

Drs. A. W. Taylor, Shephard and H. W. Elmer were 
appointed on this committee. 

The President announced that he had already selected 
essayists from two counties that had not been heard from 
for a considerable time, viz.: Dr. A. W. Taylor, of Bever- 
ley, and Dr. W. B. Graves, of Orange. 

The following appointments were then announced : 

Committee on Pollution of Streams. — Drs. E. J. Marshy 
H. Mitchell and E. L. B. Godfrey. 

Committee on Medical Inspection of Schools. — Drs. 
W. B. Johnson, H. G. Taylor and R. C. Newton. 

The Secretary announced that the common council of 
Asbury Park had taken ofHcial notice of the coming of 
the Medical Society of New Jersey in the following pre- 
amble and resolutions: 



•-90 MEDICAL SOCIETY OF NEW JERSEY. 

Whereas, The one hundred and thirty-second annual meeting of 
the Medical Society of New Jersey will be held in this city on Tues- 

■ <lay, Wednesday and Thursday of this week ; and 

Whereas, The membership of this Society and its branches com- 
prises almosl the entire body of the medical profession of New Jersey, 
and represents the highest type of professional ability and good 
^-citizenship ; and 

Whereas, This is the fifth occasion when this Society has honored 

■ Asbury Park by selecting it as a place of meeting ; therefore, be it 

Resolved^ That the citizens of Asbury Park, as represented in this 

* council, appreciating the compliment implied by the repeated choice 

' of Asbury Park as a place of annual meeting by the medical profes- 

fession, do most cordially welcome the Medical Society of New 

Jersey to our city at this time, and trust that our abundant supply of 

pure and wholesome water for domestic uses, our good sewerage, 

broad and clean streets, large lots, excellent public garbage service, 

and unsurpassed sanitary administration will so please and gratify 

4he members of this organization, and so appeal to them as being 

meritorious characteristics on the part of a pleasure resort, that they 

may be led to annually repeat this visit to our healthful, orderly and 

attractive all-t he-year- round resort ; 

Resolved, That a committee of this conncil be appointed to join the 
Mayor in conveying these expressions of welcome to the Medical 
Society of New Jersey. 

President Kirkbride appointed the following com- 
mittee: Messrs. Harvey, Wilbur and Kroehl. 

On motion of Dr. Shephard, it was unanimously 
resolved that the President and Secretary of the Society 
be requested to send a written communication in reply 
to the kindly resolutions of the common council of 
Asbury Park. 

The Secretary announced that this year there had 
1>een no representation from Atlantic, Bergen, Cape May, 
Sussex and Ocean counties. Ocean county society had 
had no representation nor sent any report for two years; 
three years without report would suspend it. 



MINUTES. 91 

Dr. Warman offered the following preamble and 
Tesolution : 

Whereas. The present code of ethics, while sanctioning a most 

Hiberal bestowal of gratuitious professional services to the worthy 
poor, whether as individuals or in public charitable institutions, and in 

-aid of the sanitary interests of the communities, yet expressly pro- 
hibits the bestowal of such services on well-to-do individuals, 

•endowed mutual benefit societies or corporations ; therefore, be it 
Resolved, That the members of the profession hired by the month 

•or year for definite wages by families, railroads, manufacturing cor- 
porations, mutual benefit societies or any money making institutions 
whatever, for ordinary surgical or medical practice, without regard to 
the amount of professional services that might be required in the 
time specified, always excepting eleemosynary and charitable institu- 
tions and those employed in the government service, in connection 
with the army or navy, are to be classed as irregular practitioners. 

.and, therefore, disqualified for membership in this Society. 

Dr. Warman explained that he not desire to press 
the matter, but simply to have it placed upon the 
minutes of the Society. 

The President said that action had already been taken 
at a previous meeting. 

Dr. Chandler moved that it be referred to the Com- 
mittee on Abuse of Medical Charity. Seconded, and 
•carried unanimously. 

Dr. Reading moved that all the papers presented at 
this meeting be referred to the Standing Committee for 
publication. Seconded, and carried. 

On motion, the Society adjourned at 1 1.20 a. m. 

WILLIAM J. CHANDLER, 

Recording Secretary , 



APPENDIX TO THE MINUTES. 



Report of the Corresponding Secretary. 

Camden, N. J., June 28, 1898. 

T<7 the Medical Society of New Jersey : 

The Corresponding Secretary respectfully reports that he has 
attended to the duties devolving upon him during the past year. 
The Transactions of this Society have been forwarded to the Secre- 
taries of the various State and Territorial Medical Associations, which 
number 48, to the Honorary Members of this Society, to the State 
Library, the New Jersey Historical Society, the libraries of Princeton 
University and Rutgers College, the American Medical Association, 
the New York Academy of Medicine, the College of Physicians of 
Philadephia, the Boston Medical Library, the New Hampshire State 
Library, the library of the Surgeon-General's office, U. S. A., the 
library of the Camden City Medical Society, and to the various 
hospitals throughout the State. In return, the Transactions of the 
Medical Associations of Georgia, Maine and Missouri, of the State 
Medical Society of Illinois, and of the College of Physicians of 
Philadelphia, have been received. Doubtless a number of other 
Transactions have been received by the Recording Secretary. In 
view of the fact that these Transactions are deposited in the State 
Library at Trenton, it would seem advisable to elect a Librarian of 
this Society, resident in Trenton. 

The By-Laws of this Society (Chap. II. Sec. 4,) provide that the 
Corresponding Secretary shall, first, keep a record of the election of 
all Permanent Delegates ; second, report to the State Society each 
year which district societies are entitled to additional Permanent 
Delegates and their number ; third, report to the State Society all 
Permanent Delegates who have forfeited their membership. 

RECORD OF PERMANENT DELEGATES. 

In compliance with these provisions of the By-Laws, the Corres- 
ponding Secretary endeavored last year to secure the names and 
addresses of all the Permanent Delegates to this Society, which were 
<luly reported to the Society and published in the Transactions of 1897. 



94 MEDICAL SOCIETY OF NEW JERSEY. 

The record of Permanent Delegates, based upon the report of the 
Corresponding Secretary for last year, is as follows : 

Atlantic County — 24 members, none. 

Bergen County — 25 members, Henry C. Neer, Park Ridge, '92, 

Burlington County — 29 members, J. Howard Pugh, Burlington, '92 ;. 
N. Newlin Stokes, Moorestown, '95. 

Camden County — 70 members, Alexander Marcy, Sr., Camden, '92 : 
J. M. Ridge, Camden, '92 ; O. B. Gross, Camden, '95 ; William H^ 
Ireland, Camden, '95 ; D. W. Blake, Gloucester City, '95. 

Cape May County — 19 members. 

Cumberland County — 34 members, W. H. C. Smith, Millville, '92. 

Essex County — 183 members, Charles Young, Newark, 92'; Johiv 
H. J. Love, Montclair, '92 ; Arthur Ward. Newark, '92 ; Joseph C^ 
Young, Newark, '92; George R. Kent, Newark. '96; William J. 
Chandler, South Orange, '96 ; Edward J. Ill, Newark. 96 ; George- 
Bayles, Orange, '96 ; Herman C. Bleyle, Newark, '96. 

Gloucester County — 22 members, George E. Reading, Woodbury ,» 
'93 ; George C. Laws, Paulsboro, '95. 

Hudson County — 59 members, John D. McGill, Jersey City, '92 ; 
Robert F. Chabert, Hoboken, '92. 

Hunterdon County — 17 members, Isaac S. Cramer, Flemington, '92 ;, 
William S. Creveling, Valley, '96. 

Mercer County— 57 members, Cornelius Shepherd. Trenton, '92 ;. 
H. M. Weeks, Trenton, '95 ; R. R. Rogers, Sr., Trenton, '95 ; David 
Warman, Trenton, '97 (elected to fill vacancy caused by death of Dr. 
Charles H. Dunham). 

Middlesex County — 23 members, John Helm, New Brunswick, '95, 

Monmouth County — 38 members, Henry Mitchell, Asbury Park,. 
92 ; Henry G. Cooke, New Brunswick, 92. 

Morris County— 46 members, I. W. Condict, Dover, '92; John S. 
Stiger, Mendham, '92 ; Levi Farrow, Middle Valley, '95. 

Passaic County — 70 members, William B. Johnson, Paterson, '92 ;. 
P. A. Harris. Paterson. '93 ; George H. Balleray, Paterson, '96. 

Salem County — 14 members, B. A. Waddington, Salem, '93. 

Somerset County — 20 members, H. G. Wagoner, Somerville, '92 ,-. 
S. O. B. Taylor, Millstone. '97. 

Sussex County— 20 members, Sibncy B. Strailey, Andover, '92 ;. 
E. Morrison, Newton, '95. 

Union County — 58 members, Alonzo Pettit. Elizabeth, '93 ; E. B.. 



APPENDIX TO THE MINUTES. 95^: 

Silvers, Rahway, '93 ; J. A. Coles, Scotch Plains, '96 ; T. H. Tomlin- 
son, Plainfield, '96. 

Warren County — 20 members, John H. Griffith, Phillipsburg, '92 ; 
William H. McGee, Belvidere, '96. 

Under date of March i, 1898, the Corresponding Secretary sent the 
following communication to the secretaries of the district societies : 

MEDICAL SOCIETY OF NEW JERSEY, 
OFFICE OF THE 
CORRESPONDING SECRETARY. 

Camden, N. J., March ist, 1898. 
Dr. , Secretary, 

The District Medical Society for the County of , 

. N. J. 

Dear Doctor: — 

I have the honor to call your attention to Chapter I, Section 4, of 

the By-Laws of the Medical Society of New Jersey, which reads as . 

follows : 

** Atthe annual meeting df each District Society in 1898, and once 
in three years thereafter, and at no other time, except in cases where 
vacancies occur as specified in the last paragraph of this section, each 
District Medical Society may, by individual ballot, by a three-fourths 
vote of the members present, select one delegate, who shall be 
eligible for acceptance by the Medical Society of New Jersey as a per- 
manent delegate, and District Medical Societies having thirty or more 
members may also, every third year, select in the same manner one 
additional permanent delegate for each thirty members; provided^ 
that every permanent delegate shall have been a member in good 
standing of a District Medical Society for five years ; and, provided, 
that no District Medical Society shall be entitled to more permanent 
delegates than one- fourth of its membership ; provided, further, that 
they present a certificate, signed by the President and Secretary of 
their District Society, in following form : 

" This is to certify that , M. D., was nominated for permanent 

delegate to the Medical Society of New Jersey, by the District Society 

for the County of , according to the requirements of the by-laws 

of the State Society." 

You are requested to furnish the Corresponding Secretary with the 

names of any of your permanent delegates who have forfeited their 

membership in your District Society, or who have died or resigned. 

since the last meeting of the State Society. 

Awaiting the favor of an early reply, I remain. 

Very truly yours, 

M. D. 

Corresponding Secretary » . 



-96 MEDICAL SOCIETY OF NEW JERSEY. 

Replies were received from the Secretaries of eight district medical 
-societies, viz.: Camden, Essex, Hudson, Hunterdon, Mercer, Middle- 
sex, Morris and Passaic. No acknowledgment of this communication 
was recived from the district societies of Atlantic, Bergen, Burling- 
ton, Cape May, Cumberland, Gloucester, Monmouth, Salem, Somer- 
set, Sussex, Union and Warren. 

ADDITIONAL PERMANENT DELEGATES, 1 898, 

Under the operation of the new By-Laws (Chap. I, Sec. 4) the dis- 
trict medical societies are entitled to additional permanent delegates 
ior 1898, who have been selected as follows : 

Atlantic, 24 members, i delegate. Bergen, 25 members, i delegate. 
Burlington, 29 members, i delegate — Addison W. Taylor, Beverly. 
Camden, 70 members, 3 Delegates — William A. Davis, Camden, and 
Maximilian West, Camden. Cape May, 19 members, i delegate, i 
vacancy — V. M. D. Marcy, resigned. Cumberland, 34 members, 2 
•delegates. Essex,. 183 members. 7 delegates — William Rankin, Jr., 
Newark; Joseph D. Osborne. Newark; Joshua W. Read, Newark; 
■George A. Van Wagemen, Newark; Richard C. Newton, Montclair; 
Charles H. Bailey, Bloomfield; Thomas S. Fitch, Orange; James S. 
Wrightson, Newark ; Lott Southard, Newark ; i vacancy — J. H. J. 
Love, deceased. Gloucester, 22 members, i delegate - James Hunter, 
Westville. Hudson, 59 members, 2 delegates— J. A. Exton, Arling- 
ton. Hunterdon, 17 members, i delegate — N. B. Boileau, Jutland. 
Mercer, 57 members, 2 delegates — Elmer Barwis, Trenton. Middle- 
■sex, 23 members, i delegate — Ambrose Treganowan, South Amboy; 
Edwand B. Dana, Metuchen ; i vacancy — C. H. Andrus, resigned. 
Monmouth, 38 members, 2 delegates. Morris, 46 members, 2 dele- 
gates - Cuthbert Wigg, Boonton. Passaic, 70 members, 3 delegates — 
John F. Leal, Paterson. Salem, 14 members, i delegate. Somerset, 
20 members, i delegate — J. P. Hecht, Raritan. Sussex, 20 members, 
I delegate. Union, 58 members, 2 delegates— T. N. McLean, Eliza- 
beth. Warren, 20 members, i delegate. 

PERMANENT DELEGATES WHO HAVE FORFEITED 

THEIR MEMBERSHIP. 

The By-Laws, Chap. H, Sec. 4, make it the duty of the Correspond- 
ing Secretary to report to this Society the names of those permanent 
delegates who have forfeited their delegateship in this Society, either 
(Chapt. I, Sec. 4) by reason of loss of membership in their respective 



APPENDIX TO THE MINUTES. 97 

district societies or by failure to attend two consecutive annual meet- 
ings of this Society. 

The Corresponding Secretary, therefore, is obliged to report that 
the Transactions of 1896 and 1897 show that the following permanent 
delegates have failed to attend the two last consecutive meetings of 
this Society : Dr. John H. Griffith, Warren District Society, '92 ; Dr. 
E. Morrison, Sussex District Society, '95 ; Dr. H. M. Weeks, Mercer 
District Society, '95. 

The Corresponding Secretary respectfully recommends that the 
names of permanent delegates who have died, resigned or forfeited 
their membership, shall be no longer printed in the list of permanent 
delegates in the Transactions. 

Respectfully submitted, 

E. L. B. GODFREY, M.D., 

Corresponding Secretary, 



Treasurer's Report. 

Dr. Archibald Mercer, Treasurer^ in account with the Medical 
Society of New Jersey : 

June, 1898. Dr. 

Atlantic County Assessment , . . $56 00 

Bergen " ** 54 00 

Burlington " " 58 00 

Camden " " 1 24 00 

Cape May " " 36 00 

Cumberland " ** 66 00 

Essex •• ** 380 00 

Gloucester ** " 44 00 

Hudson " " 1 20 00 

Hunterdon " " 38 00 

Mercer " " 11000 

Middlesex " " 40 00 

Monmouth " ** 72 00 

Morris " " 80 00 

Ocean " " 

Salem " " 26 00 

Somerset " " 42 00 

7 



98 MEDICAL SOCIETY OF NEW JERSEY. 

Sussex County Assessment $40 00 

Union " *• 104 00 

Warren ** " 44 00 

$1,676 00 

July, 1897. Balance returned from Dr. H. W. Elmer 6 00 

" Loan Howard Savings Institution 1,000 00 

Nov., 1897. Loan Howard Savings Institution 105 00 

To Cash in Bank, June, 1897 . . ? 881 98 

Interest on U. S. Bonds 102 00 

To U. S. Registered 45^ Bonds 2,250 00 

$6,020 98 
1897. Cr, 

June. By paid Wm. Pierson, Recording Secretary.. $15 75 

H. W. Elmer, Standing Committee. . 24 04 

Archibald Mercer, Treasurer 14 18 

E. L. B. Godfrey. Corres. Secretary. . 28 70 

L. J. Hardham, By-Laws 1 28 00 

The Orange Chronicle 16 50 

July. " Note Howard Savings Institution, with 

7 months' interest, 6j< 879 75 

R. C. Schulz, Stenographer 50 00 

L. J. Hardham, Transactions 886 00 



«( t( 



«< (f 



«« «* 



<* «( 



«< if 



4< If 



«< «f 



$2,042 92 

By Cash Balance in Bank, June, 1 898 i ,728 06 

By U. S. Registered Bonds 2,250 00 

$6,020 98 
Respectfully submitted, 

ARCHIBALD MERCER, 

Treasurer, 



Report of the Committee on Business. 

Gentlemen of the Medical Society of New fersey : 

The Committee on Business, in making their annual report, con- 
gratulate the Society upon the increase in the length of time allowed 
for the sessions of the Society, and predict increased interest and 
attendance upon the meetings as a result ; also upon the very satis- 
factory programme for your consideration and discussion. The 



APPENDIX TO THE MINUTES. 99 

special order — presentation of pathalogical specimens, new instru- 
ments and apparatus — introduced for the first time, it is believed, if 
fully developed, can be made an important feature of our future 
meetings. Dr. H. M. Weeks, of Trenton, having been appointed one 
of the essayists, has been displaced upon the programme by Dr. H. 
B. Costill, of Trenton, at his own request. Your committee has 
made an especial effort to have the subject for discussion selected at 
the last annual meeting — " Milk as a Culture Medium, and its Capacity 
to spread Infectious Diseases " — rendered unusually interesting, one 
of our members to open the discussion and three others to continue 
upon special lines previously selected. 

The subject selected for discussion at the next annual meeting is : 
•*To What extent is the Code of Ethics of the American Medical 
Association in operation Today ?" 

The committee would respectfully suggest that early application for 
fK>sition on the programme by members willing to present papers at 
the next annual meeting would greatly facilitate their work and, they 
believe, result in a decided increase in the good work of and interest 
in the meetings of the Society. 

Respectfully submitted, 

Walter B. Johnson, Chairman, 

T. R. Chambers, 

W. Updyke Selover. 



Report of Committee on Honorary Membership. 

The Committee on Honorary Membership and Honorary Degree of 
"Doctor of Medicine," would respectfully report that the name of 
Dr. Samuel Hayes Pennington was proposed at the last meeting of 
this Society for honorary membership, and referred to the committee. 
It is with pleasure the members of the committee fully endorse and 
recommend his election as an honorary member of this Society. 

Dr. Pennington is now the oldest Fellow and member of our 
time-honored Society, and was President in 1848, now fifty years ago. 
He was born in 1806, graduated at Princeton College as A.B. in 
1823, ^nd in 1828 as A.M. In 1829 he received the degree of M.D. 
at the Rutgers Medical Faculty, of Geneva College. During the 
ensuing thirty years he led an active professional life, locating in 
Newark, New Jersey. In the Medical Society of New Jersey he has 



1 



lOO MEDICAL SOCIETY OF NEW JERSEY. 

been an active member, contributing largely toward the promotion of 
its interests and taking a leading part in moulding and directing its 
policy. His professional standing has been recognized outside of the 
State by his election to honorary membership in the Connecticut 
Medical Society and corresponding membership with the Medical 
Society of Munich, also with the Royal Botanical Society of Rotiston. 
He is now President of the Theological Seminary at Princeton and is 
one of the trustees of the college. 

As a member of the Essex County Medical Society he has been a 
regular attendant at the meetings, and always taking an active interest 
in its proceedings. For many years he has been President of the 
Newark City Bank, of which he was one of the founders. Dr. Pen- 
nington has written many scientific addresses and essays on medical, 
educational and kindred subjects. These have borne marks of the 
scientific and classical culture, to which he is known to have devoted 
much leisure. 

H. GENET TAYLOR. 
June 28, 1898. Chairman, 



Report of Standing Committee. 

The Standing Committee, as elected at the last annual meeting of 
this Society, met immediately after adjournment and elected H. W. 
Elmer chairman. 

Dr. Henry Mitchell was appointed to prepare a paper on " The 
Progress of State Medicine and Hygiene "; Dr. W. H. Iszard. on the 
*• Progress in Medicine and Therapeutics "; Dr. Stephen Pierson, on 
" Progress in Diseases of Nose and Throat "; Dr. Mortimer Lampson, 
on *• Progress in Diseases of Eye and Ear," and Dr. H. W. Elmer, on 
" Progress in Bacteriology." As allowed by your By-Laws, Dr. 
Fayette Smith will substitute Dr. Pierson, information of which was 
gained too late for publication, and Dr. B. Meade Bolton, of Princeton 
University, will read the paper on Bacteriology. 

Your Committee returned to the custom, honored by experi- 
ence, a variation from which has not been productive of much 
advance, and issued circular letters for distribution by the reporters to 
the members of the District Societies requesting information upon the 
specified topics, and their views upon the question for discussion at 
this meeting : *' Milk as a Culture Medium, and its Capacity to Spread 



APPENDIX TO THE MINUTES. lOI 

Infectious Diseases.*' Five reporters have failed " in toto " to comply 
with the By-Laws, but the others have complied both in substance 
and as to time. We desire to express to them our thanks for their 
assistance under the usual adverse circumstances, and from them we 
gain the following information : 

In the main, there appears to be no abatement in the interest shown 
in the various District Societies ; the papers are interesting and timely, 
the discussions edifying. Atlantic reports the maintenance of its 
regular meetings, good attendance, attractive and interesting papers 
and additional membership. There seems to be no reason to regret 
the formation of the Atlantic City Academy of Medicine, instituted 
about a year ago. Its permanency seems assured, if the interest 
manifested in its proceedings and papers form a criterion of judg- 
ment. The attendance is good, interest unflagging and the attractive- 
ness is increased by the entertainment of members of the profession 
from other cities. 

The most noteworthy innovation in Burlington County Society was 
a complimentary dinner tendered to Dr. Franklin Gauntt upon the 
fiftieth anniversary of his entrance to membership. It was partici- 
patied in by the members of the Society and invited guests. Dr. 
Gauntt was President of this Society in '72. 

Camden has increased the usefulness of her Society by the addition 
of another regular meeting for the presentation of papers. Heretofore 
but three meetings were held, but a fourth being deemed necessary, 
is now held in October. At the anoual meeting in May a large brass 
tablet, artistically engraved, commemorative of the valuable services 
rendered by Dr. Joseph W. McCullough and Henry £. Branin during 
the scourge of typhus fever in the almshouse, from November 24, 
1880, to April 9, 1 881, was presented to the honorable Board of Free- 
holders. Appropriate ceremonies were held at Blackwood. The 
presentation was made in behalf of the Society by Dr. £. L. B. 
Godfrey, and received by Hon. Henry T. Wolfe, Director, in behalf 
of the Board, after which eulogistic speeches were made by prominent 
guests. In passing let me say, in this epidemic Dr. McCullough lost 
his life and Dr. Branin seriously impaired his health. 

Cape May, Cumberland and Gloucester Counties report nothing 
special beyond the continued increase in numbers and interest. 

In Hudson, a number of new societies, with limited numbers and 
rigid requirements for membership, have been formed for the object 



I02 MEDICAL SOCIETY OF NEW JERSEY. 

of special investigation and professional study, which have a good 
average attendance and are doing excellent work. 

The special event in Mercer County was the celebration of the 
fiftieth anniversary at Trenton, at which Dr. Cornelius Sheppard read 
a paper entitled, '*A History of the District Medical Society of 
Mercer County, and a Short Sketch of Some of its Past Members," 
a full text of which will appear in the Transactions. The celebration 
concluded by a banquet presided over by the President, after which 
responses were made to toasts proposed by Dr. William Elmer as 
toastmaster, by members of the clerical, legal and medical professions, 
and by the laity. At a meeting prior to the celebration, the Society 
expressed itself upon the subject of the misuse of hospital services, 
and in order to mitigate the abuse of medical charities, adopted some 
resolutions submitted by a committee previously appointed. The gist 
of these resolutions is, that applicants for dispensary treatment shall 
bring a card» properly endorsed by a recognized authority ; that such an 
applicant is unable to pay for professional services ; that a record of 
such applicants shall be kept by each institution, and submitted bi- 
monthly to a central organization ; that dispensary physicians may 
give their services to emergency cases but once, and that patients 
paying for private rooms in hospitals are not entitled to the services 
of the attending physician gratis. 

Middlesex has had but one meeting during the past year, at which 
officers were elected. 

Sussex reports poor attendance, but Salem is as enthusiastic as in 
1897 over the prospects, present and future, for good work and 
enlarged growth from frequent interchange of ideas with other 
physicians. 

It goes without saying that under the prevailing method of sanitary 
inspection and quarantine, our State has been exempted from serious 
epidemics, and while reporters do not seem to have been impressed 
with the unusual healthfulness, as in '97, yet a great degree of 
immunity from severe disease is noted, and although we acknowledge 
there are fads in all walks of life but ours, we sometimes wonder if 
the ancient malaria to which so many ills were attributed has not 
succumbed to the more modem "grippe." Malaria is rarely men- 
tioned now, but "grippe" always. 

The universally prevalent zymotic disease has been rubeola, reported 
from many sections and in some instances ending fatally from4>roncho* 



APPENDIX TO THE MINUTES. IO3 

pneumonia, as reported in Mercer County. Warren County directs 
special attention to the gastric and intestinal complications. 

Dr. Adams, of Trenton, read a papei entitled, *' A Report of 165 
Cases of Measles," at the semi-centennial meeting of Mercer County 
Society, and at the close of the discussion of the paper the Society 
expressed itself formally, "that inasmuch as there were no known 
methods of prevention of rubeola, the isolation of cases is not wise." 
This, you will recall, is somewhat in accord with the resolutions 
adopted by the Board of Health of Asbury Park in 1896. 

Of diphtheria, Mercer County reports a 16 per cent, mortality in 
1 26 cases, the lower counties of the State report isolated cases, and 
Dr. Stevenson mentions an epidemic in Haddonfield of forty cases, 
the fir^t that had appeared there for ten years. He states that these 
cases were attended about equally by the two schools, and that the 
mortality of cases under the care of the regular profession and wk0 
used antitoxin^ was nil, while ten out of thirteen cases treated by the 
other school and who did not use antitoxin, died. 

Scarlet fever existed sparingly in the many districts ; 126 cases in 
Mercer County and forty cases in Warren County are the greatest 
number reported. 

Brief mention is made of typhoid fever as having a mortality of 
10.3 per cent, in Mercer County, of a satisfactory success with Wood- 
bridge treatment in cases in Middlesex and Gloucester, of its increase 
in Camden County ; of " la grippe " manifesting itself in manifold 
varieties, and Dr. McAllister calls attention to the conjunctiva as 
medium of infection, as well as the air passages ; of pneumonia and 
of pertussis existing extensively in northern part of Sussex and the 
southern part of Cumberland, in the latter place its origin being 
traced to the Italian strawl>erry pickers. 

Many papers and cases are noticed by all reporters as having been 
presented before their societies ; some by title, of some a resum^ is 
given, and some are presented is full. For the full text of these you 
are referred to the Transactions. The papers received are ; " Dis- 
eases of the Eye dependent upon Diseases of the Nose," by Talbot 
R. Chambers, of Jersey City, a reprint from Medical Record of April 
9, 1898; '* Artificial Feeding of Infants." by^ Dr. Burdette Craig, of 
Jersey City ; ** Hydrophobia," by W. E. Darnell, of Atlantic City ; 
**A Case of Pneumonia and Abortion," by Dr. J. A. Joy, Atlantic 
City ; " A Case of Tetanus," by Dr. William Brewer, of Gloucester ; 



I04 MEDICAL SOCIETY OF NEW JERSEY. 

" A Case of Trichinosis," by Dr. George E. Reading, of Woodbury ; 
" Effects of Pressure on the Heart's Action," Dr. J. C. Johnson, of 
Blairstown. 

In the direction of improved sanitation, the reporter of Atlantic 
County again calls attention to the fact of the extreme healthfulness 
of Atlantic City and its low death-rate, challenging comparison with 
any city of its population in the world ; and an efficient Grand Jury 
in Hudson County, we are informed, is compelling a rapid abatement 
of the oft-complained-of nuisances on the meadows, which hitherto 
has been a great menace to health. The use of the Pequannock water 
is also said to add much to the pleasure and healthfulness of the 
inhabitants of the county. 

The only public institutions reporting are the Camden City Dispens- 
ary, a demand npon whose charitable services is rapidly increasing 
every year. During 1897 over 13,500 cases were treated, instead of 
about 10,000 in 1 896. The Cooper Hospital, Camden, is still doing 
very good work in its wards as well as in the out-patient department. 
Nine graduates took their diploma from the New Jersey Training 
School for Nurses, in Camden, on May 27, 1898, at which Dr. Joseph 
S. Baer delivered the annual address. 

The sentiment of the profession on the topic under discussion for 
this meeting, *' Milk as a Culture Medium and its Capacity to Spread 
Infectious Diseases," is unanimous in the affirmative; there is no 
dissent, but Dr. Stevenson thinks the number of infectious diseases 
caused by it, in proportion to the amount used, is surprisingly small. 
While the opinion is thus expressed, but few seem to have had prac- 
tical illustrations in their practices. 

In Hudson County an epidemic of typhoid fever in November was 
traced to the home of a dairyman who supplied local dealers. A case 
existed in his family. The disease was conveyed to the dairy through 
the water supply and to the milk during the process of cooling. The 
dairy was at once quarantined by the Health Board and further pro- 
gress of the disease arrested. 

Dr. Holmes, of Middlesex, narrates the history of fifty cases of 
diphtheria in Mercer County, arising in families supplied with milk 
from a dairyman whose hired boy milked the cows while suffering 
with diphtheria and whose daughter contracted the disease before the 
boy recovered. There had been no cases of diphtheria in this 
locality for many years previous to this. A somewhat similar case 



APPENDIX TO THE MINUTES. I05 

occurred in New Brunswick some years since. A member of a milk 
dealer's family had scarlet fever ; in one day scarlet fever was dis- 
covered in six families to which this dealer served milk. There were 
other cases of contagion, but the original source was promptly 
quarantined. 

Death has removed from our membership the following : 

Camden County — Henry E. Branin, Blackwood, October 6, 1897 ; 
Orange W. Braymcr. Camden, January 8, 1898. 

Cumberland County— Jona S. Whitaker, Millville. Feb. 14, 1898. 

Gloucester County — H. G. Buckingham, Clayton. 

Essex — John H. J. Love, Montclair, July 30, 1898; H. Bedell 
Crane, Newark, March 23. 1898; John Duane Brumley, Newark, 
January 8, 1897. 

Hudson County — Thomas H anion Atkinson, Jersey City, Feb. 
5, 1898; Isaac Newton Quimby, Jersey City, May 6, 1898. 

Mercer County — Charles Richard Burroughs, Trenton, November 
10, 1897. 

Salem County — William S. Patrick, Woodstown. 

Union County — Dewilt Clinton Hough, Rahway, August 25, 1897 ; 
T. H. Manning. Plainfield, May 19, 1898. 

In closing this report, your Committee would suggest that in the 
future, should societies desire insertion in the published Transactions 
full accounts of such events as they may wish to celebrate, such 
insertion be accorded them, provided they bear one-half the expense. 
Your Committee do not think papers read before this Society and 
published in medical journals prior to the Transactions, should be 
permitted to appear as part of our Minutes. 

H. W. ELMER. Chairman. 



Report of the Delegate to the New York State 

Medical Society. 

To the State Medical Society of New Jersey : 

The New York State Medical Society held their sessions at 
Mott's Memorial Hall, New York City, last October. In connection 
with Dr. Currie, I was present at their meetings. The Doctor was 
expected to write this report or furnish the material for it. At the 
last moment a telegram reached me stating that, as surgeon, he had 



I06 MEDICAL SOCIETY OF NEW JERSEY. 

gone to the front with the army. I would state, however, that we 
received a warm welcome and hospitable attention. Their papers 
had the merit of conciseness and such concentration that the intel- 
lectual pabulum was of the most fructifying character, particularly 
those on the use of antitoxin in diphtheritic cases and the early use of 
the knife in appendicitis. The honor in which our parent society is 
held always assures your delegate a warm welcome. 

Respectfully submitted, 

ELIHU B. SILVERS. Rahway, N. J. 



Paper Read by Dr. Henry Mitchell, on "Pro- 
gress IN Public Hygiene." 

The distinguishing feature of the past year within the domain of 
public hygiene has been the rapid application of laboratory demonstra- 
tions for the prevention of the spread of communicable diseases. The 
tendency to adopt the newest teachings without due consideration 
has, however, already received a check, and a more conservative 
course is again beginning to prevail. Notwithstanding the readiness 
of health officers to at once extend to their respective committees the 
most advanced measures for the protection of health, it is still true 
that the value of sanitation has not penetrated into the minds of 
municipal authorities as it should have done and as it will do. But 
local health departments are giving signs of a more promising and 
uniform course of action than that which has heretofore prevailed, 
and the public demand for a better organized sanitary service is 
apparently bearing fruit. In a recent address upon the progress of 
sanitary operations in London during the last half century. Dr. L. 
Parks states that there has been a decrease of 96 per cent, in the 
number of deaths from small-pox. 95 per cent, in the mortality from 
typhus fever. 60 per cent, in the deaths from enteric fever, and 81 per 
cent, in the mortality from scarlet fever. In phthisis the mortality 
has fallen 46 per cent., although it is still high. 

The general effect of improvement in sanitary conditions is that 
600.000 persons now reach the age of 21 years who, sixty years ago, 
would have died. In an anniversary discourse recently delivered by 
Dr. H. M. Biggs before the New York Academy of Medicine, he 
expressed the opinion that by the employment of well-directed 



APPENDIX TO THE MINUTES. I07 

sanitary measures, the deaths caused by tuberculosis can be reduced 
at least one-third. Of every thousand inhabitants of England two 
hundred years ago, fifty to eighty died each year, and the average 
duration of the life of each person bom was not more than fifteen or 
eighteen years. In New Jersey the average duration of life is now 
about fifty-nine years. 

The mortality tables of the last statistical year show a very gratify- 
ing diminution in the number of deaths from the most important 
preventable diseases, and indicate, in certain particulars at least, that 
hygienic measures are to be credited with the prolonging of many 
lives. The total number of deaths from the chief preventable diseases 
in New Jersey during the past ten years, has been 103,472, or a yearly 
average of 10,347; but during the last year the number of such 
deaths was only 9,427, showing a saving of 920 lives for the year. 
The number of deaths from diarrhoeal diseases of children was 357 
less than during the previous year, and both diptheria and typhoid 
fever caused fewer deaths than usual. Deductions from these facts 
can be more correctly reached after the records of the present year 
shall have been completed and presented, but it now seems probable 
that this saving of life will continue and that it is directly due to the 
measures which have been employed for purification of water supplies* 
the sterilization of milk, the isolation of infected persons and the 
disinfection of infected premises. 

Scientific investigations have been continued with great activity in 
every department of hygiene, and considerable modification of views 
only recently promulgated has again been necessary. The dissemina- 
tion of phthisis by bacteria contained in the moist exhalations from 
the mouth and nose of infected persons has been reported by Flugge. 
It is stated that the bacteria of tuberculosis, discharged by the acts 
of coughing and sneezing, will float in the air of closed rooms for five 
hours. It has been shown that bacteria are expelled from the mouths 
of persons speaking loudly and energetically, but when the voice is 
low and gentle no bacteria escapes. It has been found that extremely 
small movements of the air will waft the infectious particles about. 
Danger is also to be apprehended from the moisture escaping from 
the mouth and nose of persons present at surgical operations, as they 
speak, sneeze or cough, and the patient himself may infect the air of 
the room by heavy breathing. The bacteria which are disseminated 
in this manner, having undergone no attenuation by drying, are almost 
invariably virulent. 



I08 MEDICAL SOCIETY OF NEW JERSEY. 

Germano reports that he was able to find bacilli alive in diphtheritic 
membranes which had been dried at the temperature of the air after 
the lapse of four months. He states his conclusions as follows : i. — 
The bacilli of diphtheria can withstand drying for a long time, both 
in the membrane and in the tissue, and also when present in dust. 
2. — Any increased rapidity in the drying process does not affect the 
resisting power of the bacilli, either in the tissue or in dust. 3. — The 
bacillus of diphtheria survives better the more surrounded it is by 
dust, probably owing to its being protected from oxidization. 4. — 
When completely dried, the diphtheria bacillus retains its entire viru- 
lence until its death. 5. — The air can, by means of dust, carry 
diphtheria bacilli while in the living state. 

Results reached by the same experimenter with cultures of the 
streptococci of erysipelas and pneumonia are reported as follows: 
I . — The power of surviving the process of dying, depends very much 
on the way in which this process is conducted and also on the material 
with which the bacteria are mixed. 2. — In any case, however, the 
power of resistance of the streptococci is high, and can persist for 
several months. 3. — The rapidity of the drying has no effect on the 
vitality of the streptococci. 4. — The powers of resistance increase 
with the amount of material with which it is imbedded. 

He believes that the bacteria of cholera and typhoid fever can 
maintain their vitality so long as they remain moist, but their numbers 
decrease rapidly as the drying process is carried on. The plague 
bacillus does not stand dr^'ing well, but like the typhoid bacillus, it 
retains its vitality for a considerable time when smeared on garments 
or bedding. 

The bacillus of cerebro-spinal meningitis can retain its vitality for 
a long period in the dry state. 

Whooping-cough has been further investigated in Germany by 
Splewski and Hensel, and the bacterium described by them appears 
to be identical with that previously isolated and cultivated by Burger. 
Inoculations on animals were negative, yet the bacillus was believed 
to be the cause of whooping-cough, for the following reasons : The 
bacillus was present in each of the thirty cases examined, and it 
persisted during the whole course of the attack. It was found in the 
expectoration of children suffering from what appeared, at the time 
of the first examination, to be simple bronchitis, but in whom whoop- 
ing-cough developed in the course of a few days. 



APPENDIX TO THE MINUTES. I09 

At the International Conference on Leprosy, in Berlin, a report was 
agreed to which asserted that leprosy is due to the entrance into the 
blood of the bacillus leprce of Hansen and Neisser ; that the disease 
is contagious and that it is not hereditary, and that, therefore, persons 
suffering from this affection should be effectually isolated. 

The disposal of sewage has attracted increased attention, and the 
subject is to be further investigated by an English royal commission. 
The Exeter and Sutton systems for the treatment of sewage are so in 
contrast with the chemical and land treatment heretofore insisted 
upon by the Local Government Board, that it is considered necessary 
to make a new and careful inquiry into the subject, and the results of 
the investigation, when they are announced, may be expected to be 
exhaustive and conclusive. 

During an inquiry into the efficiency of the microbic methods of 
treating sewage, Mr. W. J. Dibdin is reported to have said (Exeter, 
June, 1897) that he found that the solid matters in the sewage were 
entirely demolished by the combined action of the tank and the coke 
breeze beds. Instead of having a considerable amount of sludge, 
they had nothing left but a fine silt or grit, which could be removed 
without nuisance or material expense. That is the first and most 
important point to be borne in mind in connection with bacterial 
processes, whether they were carried out by this system or by any 
other. The second point noted was that a very large reduction of the 
dissolved impurities in the sewage— from 70 to 80 per cent. — was 
effected, and complete purification was secured of the organic solids 
in suspension. The total purification was found to be 90 per cent, 
and no secondary decomposition occurred in the effluent. Mr. Dibdin 
stated emphatically that the tests has already proceeded far enough 
to give assurance that the biological treatment is preferable to any 
other for the purification of sewage. 

In this connection reference may be made to the progress of the 
-discussion of the question, " How shall the ventilation of sewers be 
best accomplished ?" Views concerning sewer ventilation have under- 
gone decided modification since the results of bacteriological examina- 
tions of sewer air were made known, and the opinion is now very 
generally accepted that the air of sewers does not carry bacteria in 
excessive numbers, but on the contrary, that sewer air is singularly 
free from bacterial life. It has been shown that the offensive odors 
emitted by decomposing sewage may be disseminated without being 



no MEDICAL SOCIETV OF NEW JERSEY. 

accompanied by bacteria and that, speaking generally, stench nuisances 
are not necessarily accompanied by the germs of disease. Offensive 
odors from organic material may be regarded as a warning that the 
true source of danger is not far off, but we are not yet warranted in 
stating that the presence of such odors implies the presence also of 
the specific organisms of any of the communicable diseases. 

The tendency of the discoveries concerning the nature of sewer air 
has been toward the opinion that the efforts which have in recent 
years been made to prevent the entrance of so-called sewer gas into 
dwellings, have been justified only because its admission may create 
a stench nuisance and detract from the enjoyment of pure air. Per- 
haps, however, the Vienna experiments, showing that animals which 
had been exposed for long periods to sewer air, were more susceptible 
to attacks of pathogenic bacteria when they were introduced sub- 
cutaneously, than were the control animals which were similarly 
treated in all respects, except that they breathed pure air instead of 
sewer air. 

These investigations may hasten the time when the courts will 
hold that all conditions which impair the purity of the air are injurious 
to the public health, aud render the individual less resistant to the 
real danger when it may chance to occur. Further experience in the 
testing of subsurface drains and systems of interior house drainage 
for leakage, by air pressure and by smoke, has strengthened the 
conclusion heretofore reached, that such constructions are, almost 
without exception, pervious to air, and it is doubtless true that the 
main defence against the exit of drain air from drain pipes into 
dwellings is to be found in free openings to the outer air at the foot 
of the house drain and also at its upper termini, with such additional 
ventilation of traps as may in each case be found necessary to prevent 
siphonage and loss of seal by back pressure. By this method of 
construction the constant flushing of the drain with a flood of fresh 
air so dilutes the offensive gases emitted by the passing sewage, that 
any injurious results from the escape of such gases into the house are 
minimized. 

Foot ventilation of house drains is rendered impossible by the 
omission of a trap on the main drain, and even if no other considera- 
tions demanded this barrier against the admission of air from the 
street sewer to the premises, the foregoing reason is in itself sufficient. 
A recent writer has said that " a drain without an intercepting trap 



APPENDIX TO THE MINUTES. Ill 

is like a house without doors and sash to close the openings, and 
invites and admits the very evils which it was expressly intended to 
defend against." 

The methods by which typhoid fever is spread have been inquired 
into from time to time during the past few years, with results tending 
to show that sewer gases are incapable of disseminating this disease. 
In Germany, Flugge, Preusnitz, Rubner and Lovka have announced 
their confirmation of this view, the last-named investigator having 
demonstrated by statistics that the inhabitants in cities provided with 
sewers were not more liable to attacks of this disease than those 
residing in localities wholly und rained. Indeed, he proved that in a 
series of towns which had recently been sewered the mortality from 
typoid fever had diminished, and that in those parts of these towns 
when the sewerage was defective or wanting, cases of typhoid fever 
were more frequent and more severe than in those portions which 
were well drained. These facts do not indicate that good drainage or 
bad drainage has any direct influence upon the causation of typhoid 
fever, but they confirm the view that the natural immunity is impaired 
by dwellings in unsewered districts, because in these localities the 
soil receives all of the fluid waste products and the ground air finally 
becomes vitiated and unwholesome. The gases of putrefaction, how- 
ever unwholesome they may be, cannot produce typhoid fever nor any 
other specific disease, but they undoubtedly can so lower the resisting 
power of the economy that pathogenic bacteria find little to oppose 
or retard their growth when they have become planted in the alimen- 
tary tract or elsewhere. 

Nageli has shown that bacteria are not readily given off from sewage 
nor from the moist surfaces of the interior of sewers, and the air of 
sewers has been found to be almost free from these organisms. 
Uffelmann has failed to find in sewer air any bacteria which have 
been identified as having relation to the causes of disease, and this 
writer asserts that the gas or air of sewers proves injurious to health 
only when highly concentrated and when putrefying matters accumu- 
late. In well constructed sewers the sewage passes away freely 
and without putrefaction, and the air of such sewers is in no way 
unhealthful. 

The vitality of the typhoid fever bacilli in sewage was reported 
upon by Mr. Parry Laws and Dr. F. W. Andrews in 1 894, and they 
raised serious questions as to the survival for any length of time of 



112 MEDICAL SOCIETY OF NEW JERSEY. 

this bacillus as it exists in an ordinary sewer. It appeared from their 
experiment that sewage does not form a medium in which growth of 
the bacilli readily takes place, and they found that these organisms 
underwent destruction in a few days, or at most in one or two weeks. 
Some recent work by Delepine suggests that the bacilli may have 
greater power of resistance under certain favorable conditions than 
was indicated by the result obtained by earlier observers, but the best 
experimental evidence that sewage does not, under ordinary circum- 
stances, give up the bacteria which it contains to the air in contact 
with it, is almost unanimous, and it seems to be proven that the 
species of micro-organisms present in sewer air are those related to 
the outer air and not to those present in the sewage. Thus we arc 
led to accept the view that the conveyance of the typhoid fever germs 
by sewer air must be at least very exceptional, and no proof has yet 
been produced to show that the disease ever arises as the result of 
the escape of sewer gases into the open air. 

Further researches by M. Thiroloix have been made concerning the 
microbic origin of acute articular rheumatism, and he reports that 
since March, 1897, he has found the pathogenic bacillus in the blood 
of five persons who were suffering from this disease. Intra-venous 
injections of this organism uniformly produced cardiac and pleuro- 
pulmonary lesions, and also the characteristic articular symptoms. 
He gives it as his opinion that the cardiac lesions may exist without 
the articular inflammation, and the disease, therefore, may not always 
be recognized as rheumatic in its character. 

During the past year an international sanitary conference assembled 
at Venice in connection with the epidemic of bubonic plague in the 
East, and steps were considered for the prevention of the entrance of 
this disease into Europe. It was agreed upon that for administrative 
purposes the incubation period should be held to be ten days, although, 
in fact, it is generally admitted that the incubation period is from three 
to four days. The conference unanimously agreed upon a system of 
notification under which each government is to notify other govern- 
ments of the existence of plague within their several jurisdictions, and 
to state the measures which are being carried out to prevent its spread. 

The terms " isolation," *• surveillance " and " observation " were 
defined as follows : Isolation of the sick consists in their absolute 
separation from all uninfected persons and in their detention under 
official direction. Surveillance and observation signify supervision 



APPENDIX TO THE MINUTES. II3 

without detention and under this system the passengers are allowed 
to proceed lo their own homes, where they can remain under medical 
care as long as the authorities deem necessary. 

Popular interest has been aroused concerning the time-honored but 
not very acceptable methods employed by barbers in carrying on their 
trade, and much has been written by the members of our profession 
in condemnation of the application of dirty hands, dirty towels, 
sponges, brushes, soap, puffs and pads to the faces of the patrons of 
the barber shop, but in only a few shops in the country have steps 
been taken toward the introduction of aseptic precautions in con- 
ducting this business. Inquiry among the manufacturers of stenlizing 
apparatus does not show that any suitable, convenient and efficient 
appliance for the use of barbers has yet been offered to the trade. 
The following rules may be laid down as an outline of requirements to 
which the modem barber should conform in conducting the operation 
of shaving: 

1. The barber should clean his hands by the use of soap, water 
and a nail brush. 

2. Apply to the beard soap paste, using the hands only. No brush. 

3. Use razor which has been kept in sterilizing oven. 

4. When razor becomes dull do not strop it and return it to the 
face, but take another razor from the sterilizer. 

5. Use no large cloth spreads, but towels only to protect the 
garments of the customer. Use no sponges, puffs, pads nor mag- 
nesia cake. 

6. Provide large sterilizing oven in which the temperature can be 
kept evenly at 230^ F. and in this oven keep a supply of towels which 
have been previously washed and boiled. Keep also in the oven a 
supply of razors ready sharpened for use. Razors should have metal 
handles. 

7. Use metal hair combs. They should be washed after use and 
kept in sterilizer. 

8. Hair brushes, if used at all, should be regularly and frequently 
washed and kept clean. 

Before closing this review of the general progress in the act of 
disease prevention, let me bring to your attention the opportunity 
which is now offered by the authorities of Rutgers College to persons 
engaged in, or those who may desire to pursue the occupation of 
sanitary inspectors, to demonstrate their fitness for this calling. A 

8 



114 MEDICAL SOCIETY OF NEW JERSEY. 

board of examiners has been appointed to inquire into the knowledge 
and ability of applicants, and certificates of capability are issued to 
those who are found to be entitled to such an evidence of familiarity 
with the recognized methods of municipal sanitary administration. 
We may reasonably expect that this movement will lead to the 
employment of sanitary officers of a superior type, and that inefficient 
and incompetent persons will be, in course of time, replaced by men 
who have been prepared to perform skillful service. 



Paper read by Dr. Edward L. Bull, on " Progress 
OF Ophthalmology and Otology." 

. Ophthalmology. 

The progress of ophthalmology for the past year has been more in 
the line of discussion of papers and perfection of operative technique 
than in the production of new books, new instruments or the 
advancement of new operative procedure. To give even the conclu- 
sions derived from the many discussions would require a book of no 
small size, and in an article of this kind one can give only in the 
briefest manner a few of the many interesting developments. 

A notable event of the past year was the meeting at Glasgow, in 
August, 1797. of the International Congress. The proceedings of 
the ophthalmological section are reported m full in the January, 1898, 
volume of the " Archives of Ophthalmology," and the session is 
spoken of as being a success in every way. Dr. Uhthoff read a paper 
on ** A Bacteriological Classification of Corneal and Conjunctival 
Inflammations." Dr. Uhthoff claims that such a classification is not 
yet possible and we are compelled to rely upon clinical appearances. 
Of the serpiginous ulcers of the cornea, we may consider the Frftnkel- 
Weichsiebaum diplococus the cause, and whether other micro-organ- 
isms can give rise to the same clinical picture is still doubtful. The 
pathogenisis of trachoma is not yet known nor are the micro-organ- 
isms of follicular catarrh, which are, perhaps, the pseudo-gonococci. 
(Arch. Ophthal., Jan., '98.) 

Dr. Knapp, of New York, read a paper describing his recent 
experience with cataract operations, 1,050 in number, the last 400 
including all complicated cases. The method of operation was 
usually simple extraction without iridectomy, and the incision was 



APPENDIX TO THE MINUTES. 11$ 

made at the border of the transparent cornea, almost half its extent ; 
the capsule was opened with a cystatome to the extent of 5 or 6 m. m. 
in the upper part and underneath the iris, so that the torn pupilary 
edge of the iris and the wounded capsule should not touch. Pressure 
at the lower part of the cornea easily delivered the lens. Contact of 
the border of the lid and the corneal wound should be avoided ; both 
eyes bandaged and dressing changed after twenty-four hours, when 
any prolapse of the iris can be disposed of. Reaction of an inflam- 
matory and mechanical nature was limited to six cases of slight iritis, 
two cases of partial wound inflection and four cases of purulent inflam- 
mation of cornea. In 355 operations, prolapse of iris occurred fifteen 
(15) times (7.6^ and was successfully healed by iridectomy. Second- 
ary operation was done in 40^ of the cases. In three cases, glaucoma 
following discission was observed ; recovery was obtained by iridectomy, 
eserine and morphine. Final result in last 400 cases not quite as 
good as in previous 600 cases, still, good vision was obtained in 93^, 
fair in 4.$^. and in 2.4^ there was total failure. In the first series of 
600 cases, in two instances both eyes were lost from sympathetic 
ophthalmia; the cataracts in these cases were complicated. Dr. 
Knapp concludes with the statement that simple extraction has yielded 
him greater distinctness of vision, fewer failures and better final 
results than any other method. (Arch. Ophthal.. Jan., '98.) 

Fukala, writing on the subject of operative treatment of myopia, 
quotes from 2,000 cases already reported. His method of operation 
was free diversion of capsule and lens, and in three cases direct 
extraction was done without good results ; extreme myopia seemed to 
retard sclerosing of lens. After three to Ave days from time of 
diversion of capsule and lens, extraction followed. Disagreeable 
consequences, such as stretching of parts of the lens in the wound 
and anterior synechia, are easily gotten rid of, but cyclitic disturbances 
require great attention. Eyes which are, in spite of correction for 
myopia, no longer useful, should be operated upon. In adults the 
low limit is lo.oD ; in children. 8.0D. The operation may be done 
up to 60 years. (Arch. Ophth., Jan., '98.) 

Dr. William Holland Wilmer. of Washington, D. C, reports a case 
of excessive myopia treated by extraction of the transparent lens. 
The patient, a lady school teacher. R. E. V. yir-iWr w— 25.0DS 
{ )— 2.50 D.C. axis iqo. L. E. V. ^\\^ w— iS.o Ds ( )— 2.50 
D C. axis 180*'. Right eye operated upon ; pupil dilated with atropine ; 



Il6 MEDICAL SOCIETY OF NEW JERSEY. 

cornea anaesthetized with ^^ cocaine ; lens freely needled, care being 
taken not to wound vitreous ; ice applications ; no pain ; no inflam- 
matory reaction ; only moderate swelling of lens substance. Five 
days after needling, the opaque lens was extracted ; upon completing 
section, soft lens presented through opening in capsule made by 
previous needling, it not necessary to use cystatome ; no vitreous lost. 
Vision ^^ without glass. Final result, |f +w~2.25 Ds ( ) —0.75 
D.C. axis 180^. Patient uses right eye for distance and left eye for 
near work. Is so well pleased that she is determined to have left eye 
operated upon. (Oph. Record, Jan., '98.) 

Vossius operated on 21 patients for excessive myopia. The average 
increase in vision was -^ to i, the highest \, Chorordal affections 
do not contra-indicate the operation ; detachment of the retina was 
not observed. (Arch. Ophth., March, '98.) 

Frdhlich operated on 30 patients for excessive myopia. After eUs- 
cission : In 1 case he observed incarceration of the pupilary margin 
of the iris in the puncture; in i case, cloudiness about the puncture; 
in 3 cases, posterior synechias ; in i case iHtis with thick secondary 
cataract, and in 2 cases, glaucomatous increase in tension. After 
linear extraction'. In 6 cases, incarceration of iris; in 4 cases, heal- 
ing of lens capsule in corneal wound ; in 2 cases, iritis with hypopyon, 
and in 5 cases, posterior synechia. After secondary operation : In i 
case, detachment of retina; in 2 cases, detachment later, and in 2 
cases increase in fundus changes. The course was normal in 23 of 
the 50 eyes operated on. (Arch. Ophth., March, '98 ) 

Chalupecky endeavored to ascertain the effect of Roentgen rays 
upon the eye. A rabbit was exposed to a lamp of 12-16 amperes at 
a distance of 10 c. m. two hours daily up to thirteen hours of exposure. 
No ill effects were noticed excepting myosis and lachrymation. The 
hair in the region of the eye and cheek began to fall out and a con- 
junctivitis developed, resembling a diphtheritic process. The other 
side of the head was not affected. Roentgen rays, like the ultra- 
violet rays, affect slowly the anterior portion of the ball, while they 
are absorbed in considerable measure by the inner media including 
the lens. (Arch., Jan., '98.) 

The following is a summary of the cataract operations done at the 
New York Eye and Ear Infirmary from October, i, 1896. to October 
I, 1897. The report is taken from the New York Eye and Ear 
Infirn)ary Reports, January, 1898, and was compiled by John P. 



APPENDIX TO THE MINUTES. 11/ 

Davidson, M.D. This tabulated report docs not include the opera- 
tions for lens extraction made necessary by traumatic conditions nor 
those for capsular cataracts, for which the primary operation is not 
reported here. Several operations were performed upon patients 
where the functional examination did not promise good results in so 
far as restoring sight was concerned, but other reasons were sufficient 
to warrant the undertaking. One hundred and forty-^ne operations 
furnished oru case of intra-ocular hemorrhage and two of panoph- 
thalmitis. The case of intra-ocular hemorrhage occurred in a patient 
who was myopic and where the projection was faulty. Blood was 
discovered on the bandage twelve hours subsequent to operation. 
One case of panophthalmitis occurred where there was a chronic 
conjunctivitis with some discharge ; the second, however, was a case 
for which no cause could be assigned. All operations were done 
under cocaine anaesthesia except where general anaesthesia is men- 
tioned. Aseptic measures were employed in all cases. The average 
period of time the patient remained in the house was 16.5 days. The 
percentage of different operations were as follows: Simple extrac- 
tion, 75.71^; extraction with irredectomy. 20.71^; extraction following 
pulminary irridectomy, 2.87^; primary discission, 0.71^; discission 
for capsular cataract, 21.42^; prolapse of iris occurred in 11.32^. 
The average time after operation where prolapse of iris occurred was 
2.7 days. Average of recorded immediate vision, -^i average of 
recorded ultimate vision. fJ + CiVV). Of the recorded immediate 
vision, 8^ had |J ; i.6ii, |J: 5.64^, |^; 11.29^. ^; 21.77%, t% '• 
22.585^. //V; 24.88^, less than /q%; 12^, ^ly- Of the recorded ulti- 
mate revision, 11. 11^ had |»; 18.51^, fg; 25.92j<, fj; iS.S7%, H; 
11.11%, ^; ii.S%*-Anf\ 3-8jf. less than ^. 

Dr. A. Barkan, San Francisco, Cal., reports in the March, 1898, 
Archives, the removal of a large piece of steel with Haab's electro- 
magnet. Patient aged 28 ; employed in boiler shop ; was struck in 
left eye by a piece of sfeel from a hammer. The wound was in the 
outer half of sclera, two-thirds of a centimeter from corneo-scleral 
margin, slightly below the horizontal meridian. The .wound was 
enlarged wirh scissors and Haab's electro-magnet applied within on^- 
quarter of an inch from the wound. The patient felt a sharp pain 
for a second and the chip of steel (size 7x3 m. m., weight 48 mg.) 
was found adhering to the pole of the magnet. Under ordinary 
treatment patient did well as far as eye was concerned, but later 
developed delirium tremens and died. 



Il8 MEDICAL SOCIETY OF NEW JERSKY. 

Herrmann visited 34 places in Syria and PHlesline for the purpose 
of studying trachoma in the schools. Three thousand one hundred 
and six pupils were examined and many dispensaries were visited. 
He found no eye disease peculiar to the country, but much acute and 
chronic conjunctivites and trachoma, depending upon lack of cleanli- 
ness and bad hygienic conditions. In the schools of Syria 33^ of the 
pupils were affected with eye disease, trachoma making up 1 5^ : in 
the schools of Palestine 60^ had eye disease, trachoma being found in 
515^. (Archives Oph.. March, '98.) 

Trussow recommends for the surgical treatment of pannus that the 
conjunctiva be strewn with cocaine powder and the granulations be 
expressed with forceps and then the conjunctiva rubbed with i-iooo 
bichloride solutiom until it bleeds. 

Galvanization of the eye was employed by Markow in a case of 
tedious recurrent iritis with hypopyon, with remarkable effect. Since 
then galvanization .has been much used in various suppurative affec- 
tions seen at his clinic. A current not stronger than ii-2 m. a. is 
applied for five minutes, the anode on the closed eye, the cathode in the 
region of the cervical sympathetic or an indifferent spot. He begins 
with -^ m. a. Treatment is continued 2-15 days. (Arch., March, '98.) 

Marshall demonstrated from microscopical section what has long 
been held clinically by many, that the so-called interstitial keratitis is 
not simply keratitis, but really a uvitis. He shows that almost the first 
manifestation of the disease is in the form of a serous iritis and that 
the irisciliary body and chroid are always involved. For this reason 
he deems atropine the chief local remedy, particularly in the early 
stages. (Archives, March, '98.) 

Otology. 

In no branch of medicine or surgery has there been more painstak- 
ing study and advancement in the past few years, than in the treat- 
ment of diseases of the ear and the surgery of the aural and adjacent 
intra-cranial cavities. During the past year the diagnosis and treat- 
ment of intra-craniarcomplicationg' of diseases of the ear, have been 
thoroughly discussed, a number of operations on the sigmoid sinuses 
reported and much advancement made. "A contribution to the symp- 
tomatology and treatment of pyaemic synus thromboses, based upon 
three successful operated cases," is the title of a very exhaustive and 
interesting paper by Fred. Whiting, M.D., reported in the March num- 
ber of the " Archives of Otology." According to Dr. Whiting's paper. 



APPENDIX TO THE MINUTES. 1 19 

statistics show that one-quarter of all cases treated by the otologist 
are chronic suppurative diseases of the middle ear, and it is from this 
large class of cases that the victims of intra-cranial lesions are re- 
cruited, acute inflammation of the ear being almost exclusively free from 
such sequlae. The sigmoid sinus is the most frequently involved, and 
from its anitomical relation to the temporal bone and middle ear, 
possesses the most clinical interest for the otologist. 

Infective sigmoid sinus thrombosis is always secondary to some 
infective inflammation and is dependent upon the introduction into the 
sinus of septic micro-organisms, which originated somewhere in the im- 
mediate vicinity, and in the vast majority of cases, is due to the 
presence of chronic suppurative disease in the middle ear. The path 
of infection in septic brain disease is most commonly the direct one of 
immediate extension from diseased bone lying in contact with the 
contents of the skull. When the bone is found healthy, the path of 
infection is through the fissures in the roof of the tympanum or 
antrum, or through disease of small veins of the bone which 
empty into the sinus. In regard to diagnosis. Dr. Whiting says , ** In 
a typical case where the chronic suppuration of the ear is recognized, 
associated with repeated and severe chills, sudden and excessive rise 
of temperature with rapid remissions, the establishment of metas- 
tases, either central or peripheral, and obstruction of the jugular, 
sufficiently pronounced to be recognizable to the touch, does not offer 
great difficulties." But it is highly essential to the successful prose- 
cution of treatment that the condition be recognized if possible, before 
the establishment of those symptons constituing unquestionable 
pyaemia — that is to say, in the early septic stages. Here the presence 
of Griesinger's symptom — oedema of the region of the occipital vein 
with marked tenderness on pressure in the upper portion of the post- 
cervical triangle — will be a guide, and if the not thoroughly accepted 
Gerhardt symptom of diminished flow through the external jugular 
of the affected side can be determined, with rigors and sudden rise 
and remission of temperature, with occasional vomiting and perhaps 
oedema of the eyelids of the affected side, with paresis of one or more 
nerves located in the region of the cavernous sinus, the diagnosis, if 
not assured, is at least sufficiently probable to justify one in taking the ' 
step which, no matter how pronounced the symptoms may be, must 
ultimately be resorted to for absolute proof of the presence of sinus 
thrombosis, viz., operative investigation. 



I20 MEDICAL SOCIETY OF NEW JERSEY. 

When to operate. K6mer voices the sentiment of the great 
majority of operators, there being practical uniformity in the advocacy 
of immediate operation upon the sinus as soon as we are certain of its 
being the site of obstructive phlebitis. This appears to be rational 
treatment, for with the thorough removal of the clot, the danger to 
the patient of any futher infection is removed, while the presence of 
the thrombus is a continual menace to life not to be tolerated, not- 
withstanding in a few instances it has remained inocuous and become 
organized. In regard to the operation — and surgeons may be divided 
into two groups, those who favor jugular ligation and those who 
oppose jugular ligation — a perusal of the literature sinus thrombosis 
must, it seems to the writer (Dr. Whiting), convir.ce everyone of the 
value of jugular ligation as a safeguard against metastatic involve- 
ment of the lung and other organs, and that the additional shock to 
the patient, when the operation is rapidly and skillfuly performed, is 
outweighted by the increased immunity thus afforded from general 
infection. Dr. Whiting reports at length three cases of pyaemic throm- 
bosis of sigmoid sinus, in which he operated successfully. In his con- 
clusion he calls attention to the fact that where the jugular has been 
tied in two places, the wound heals more rapidly and satisfactory if 
the jugular is resected and not left in the wound. 

A very interesting paper reported in the " Archives of Otology," 
Feb., '98, is that by John C. Lester, M.D., and Vincent Gomez, M.D., 
on " Observations made in the caisson of the new East River bridge 
as to the effect of compressed air upon the human ear." The ages of 
the cases examined ranged from 20 to 40 years. Their occupations 
were as follows : Physicians 5, mechanical engineer i, foreman i, 
electrical engineer i. From the facts obtained and from the obser- 
vations made, the following conclusions were formulated : That for 
aerial and bone conduction the reaction of the tuning forks is markedly 
diminished, this being especially true of the higher notes. That bone 
conduction is affected to a greater degree than xrial conduction. 
That this is probably due to a hyperesthesia of the labyrinth or some 
analagous disturbances, the effect of which are more pronounced on 
the lower portion of the cochlea. That the hearing power, both for 
aerial and bone conduction, is reduced directly in proportion to the 
the atmospheric pressure. That the lower tone limit was unaffected, 
being 16 d. v. in all cases, both before and after entering the caisson. 
That the hearing distance for both the whisper and speech was 
markedly decreased in the caisson. 



APPENDIX TO THE MINUTES. 121 

That certain vowel and consonant sounds are heard with difficulty or 
not at all. For example : In one case the letters P and G were not 
heard at all ; in another, C and G were not heard ; another case failed 
to hear G and L, and still another failed to hear H and B. That the 
hearing distance for the watch decreased in all cases in the ratio of 
nearly one to twenty (1-20). That the effect of the aforesaid laby- 
rinthine disturbances persisted for varying intervals, from twenty-four 
to forty-eight hours, in persons not accustomed to the action of com- 
pressed air. That a pressure of one-half an atmosphere is sufficient to 
cause depression of the drum membrane. That a pressure of two 
atmospheres causes marked disturbances of the drum membrane, 
accompanied with congestion of the maleolar plexus and of the 
membrane flaccida. That in some cases this depression is sufficient 
to cause displacement of the ossicular chain and persistent tinnitus. 
That in descending into the caisson, while in the lock there is great 
danger of the drum membrane being ruptured if care is not taken to 
perform Valsalva's experiment. That persons suffering with coryza, 
a slight cold or congestion of the naso-pharyngeal mucous membrane 
from any cause, must not attempt to enter the caisson. That this has 
been found equally true of persons who have b^n accustomed to 
entering and re-entering the caisson for years. 

That persons suffering from chronic ear disease, especially the 
sclerosing types, must likewise avoid entering the caisson. That 
those affected with labyrinthine disease, especially if the semi-circurlar 
canals are involved, should be cautious not to enter the caisson, owing 
to the great danger of vertiginous symptoms occurring while in the 
** lock." That the effect on the heart and general circulation is such 
as to render it dangerous for those with weak or diseased circulatory 
apparatus, to enter the '* lock " or caisson. That the action of the 
heart is accelerated, the radical pulse being increased from seventy or 
thereabouts, to one hundred and twenty beats per minute. That 
persons of a hyper^esthetic or neurotic temperament should avoid 
entering the caisson. Thai the compressed air offers sufficient resis- 
tance to prevent whistling, especially the high notes. That the 
atmosphere of the caisson although generally humid, causes extreme 
dryness of the fauces and all exposed mucous membranes. 

Probably the most complete description of the technique of the 
mastoid operation ever published in English, is that by Edward B. 
Dench in the report of the New York Eye and Ear Infirmary, January, 



122 MEDICAL SOCIETY OF NEW. JERSEY. 

'98. Dr. Dench also describes in the same paper, the technique of 
operative measures for the relief of intra-cranial complications of ear 
disease. 

At the Moscow International Congress, Doctor Botey reported* 
after trials on the dead and on animals, having punctured the 
round window six times on the living. The puncture is carried out 
under all antiseptic precautions. The position of the round window is 
usually easily found. Botey has observed in cases where deafness 
was associated with unbearable tinnitus and severe vertigo, that 
puncture and asperation have relieved the vertigo and tinnitus, but the 
deafness remained unaffected. 

The subject of operations on the ossicular chain, in non-suppur- 
ative chronic middle ear disease, is one which has received a great 
deal of attention and has been discussed in every aural society. 

Some operators report very flattering results and strongly advise 
operative procedure, while other equally skillful operators report either 
failure to relieve or even aggravation of the symptoms for which the 
operation was done. Cheatle has obtained the opinion of many of 
the leading aurists as to the value of intra-tympanic operations iiv 
these cases, and ihe conclusions he draws from them are not very 
encouraging. Zimmermann says : " In all cases where negative 
Rinnd becomes positive after paracentesis, an improvement in the 
hearing may he promised after operation ; in all other obstinate cases 
an operation may at least be tried." His operation consists in 
removal of the membrane tympani and the hammer, the outer wall of 
the atic and a portion of the posterior osseous wall are chiselled away 
from the auditory canal with the aid of the author's protecting gouge. 
After the operation, hearing for voice has been increased four-fold. 

In a paper read before the Moscow International Congress on 
" The Surgical Treatment of Otitis media sica," Dr. Moure says :. 
*' Surgical treatment of catarrhal otitis (sclerosis) is indicated when- 
ever all other treatment (air insuflation, direct and indirect massage> 
has proved unavailing. It should be preceded by exploratory myrin- 
gotomy because of its great prognostic value. Patients who hear 
better after this can be successfully operated upon. The operation 
consists in the removal of the drum membrane and the ossicles,, 
except the stafes ; it can readily be performed through the auditory 
canal. The results of the surgical treatment do not show in every 
case an improvement in hearing or disappearance of the tinnitus; 



APPENDIX TO THE MINUTES. 1 23 

frequently the former is improved, while the latter remains the same, 
or vice versa. Our experience thus far does not permit us to judge 
the length of improvement. When the operation has proved a failure, 
an artificial drum in the form of a cotton pledget, soaked in ten per 
cent, carbol-glycerine, can be tried with benefit. The ear must be 
frequently examined, as the artificial drum membrane may cause a 
serous exudate. 

In discussing this paper Politzer says : " A surgical cure cannot 
be expected in cases of ossification about the oval window and extend- 
ing into the labyrinth ; even in commencing ossification of the oval 
window, the removal of the ossicles is without avail. When adhe- 
sions exist which impede the mobility and without an ossifying process 
at the oval window, the extraction of the stafes may be of benefit, as 
a new membrane can be formed." Cozzolino favors the conservative 
treatment of these affections. Botey operates only in adhesive 
processes after inflammations or chronic catarrhs. 

In conclusion. I would call your attention to an article in the New 
York Eye and Ear Infirmary report, Jan., '98, on "Significance of 
Aural Polypi in connection with carious disease of the tympanum and 
accessory cavities," by Dr. Fred. Whiting. Dr. Whiting says : *'In this 
consideration, it should be distinctly understood that by polypi are 
meant those inflammatory formations which are found only in chronic 
suppurative conditions of long standings and which, in the majority of 
instances, have their origin in and site upon some carious point in the 
osseous wall of the tympanum ; this in contradistinction to so-called 
polypoid proliferations or granulations which make their appearance 
frequently during purulent inflammations of short duration, and which 
grow with equal luxuriance from any excoreated tissue, either in the 
canal or tympanum." That the removal of such polypi is not without 
danger, is shown by the fact that in two of the cases reported by Dr. 
Whiting, acute mastoiditis followed the operation, and in a third case 
thrombosis of the sigmoid sinus developed. These complications de- 
veloped within twenty-four hours after removal of the polypi and curet- 
ting of the granulation tissue. Dr. Whiting thinks the granulation tissue 
acts a conservative part by preventing absorption, and its removal 
opens up a channel for the transmission of pyogenic germs to the 
mastoid and sigmoid sinus. The conclusions derived from this paper 
are not that no attempt should be made at the removal of the polypi 
and granulations, but rather that the procedures so instituted should 



124 MEDICAL SOCIETV' OF NEW JERSEY. 

be more thorough and under all circumstances include the extirpation 
of any eroded bony surfaces, and that such operations ought to be 
undertaken only at the hands of those who possess the requisite skill 
and the moral fortitude to successfully meet any complications which 
may anse from the infection to which the so-called simple operation has 
exposed the patient. 



Paper Read by Charles Young, M.D., Newark, 
N. J., ON ** Progress in Surgery." 

In consequence of a misunderstanding, which was rectified but a 
short time before the session of the Society, the reporter on '• Surgical 
Progress " has been compelled to greatly curtail the paper herewith 
presented. There is little new. Progress has been made in elucida- 
tion of questionable points. Accurate case-recording and unbiased 
reporting of cases will aid in determining questions here noticed and 
which are still subjudice. 

To the May number of The American Journal of Medical Sciences^ 
Andrew J. McCosh, M.D., clinical lecturer on surgery at the College 
of Physicians and Surgeons, New York, contributes an article on 
The Surgical Treatment of Epilepsy. He gives detailed his- 
tories of fourteen cases. His conclusions are summarized as follows : 
In general, the operation is indicated : i — In all cases of local or 
partial epilepsy (Jacksonian) where the convulsive movements or par- 
alyses are limited to a particular group of muscles. 2 — In all cases 
where the epilepsy, be it general or partial, has followed and is appar- 
ently caused by a depression in the skull, the result of a traumatism. 
3 — In many cases where a severe head injury, even though there be 
no external evidence, has been followed by a partial epilepsy, and where 
the signal symptom indicates a definite area in the brain. The final 
result in the 14 cases, one year or longer having elapsed since the 
operation and also since the last manifestation of cerebral disturbances, 
is as follows : Cured. 3 ; improved, 5 ; unimproved, 4 ; unknown, 2 ; 
died, o. 

The London Lancet of May 14, 1898, quotes from Revue des 
Sciences Medicates, an abstract of a case published by M. Lermayez, as 
follows : A woman 30 years of age entered the hospital to be treated 
for septicaemia, consequent upon an old otorrhea. There were severe 
pains in the temporo-sphenoidal region. A hard cord was formed by 



APPENDIX TO THE MINUTES. 12$ 

the thrombosed jugular vein, so that thrombo-phlebitis of the lateral 
sinus probably existed. Intervention was decided upon, but the 
situation became aggravated and a new phenomenon appeared — 
dilatation of all the veins of the scalp without participation of the facial 
veins. This enabled M. Lermayez to diagnosticate thrombosis of the 
superior longitudinal sinus. An operation was performed and an 
extra-dural abscess evacuated, but the sinus thrombosis was too ex- 
tensive for the removal of the clot entirely. The patient died. The 
necropsy confirmed the diagnosis. 

The Treatment of Tetanus by Antitoxin is still on trial and 
a conclusion as to its merits is apparently no nearer than at the time 
of the last report. The Munch, Med, IVocken, 1897, Nos. 32, 33 and 34, 
contains an article on the subject by Engelmann, of Curschmann's 
Clinic. He records 3 cases of tetanus of severe type, all ending in 
recovery. Two of them were treated by the Tizzoni-Cattani anti- 
toxin and one by the new serum of Behring. Case i. — set. 42, symp- 
toms appeared 7 days after wound in the face and spread to the 
trunk 5 days later. Injection given on 9th day. Improvement at 
once. Five injections in all were given, containing 9 grains of dried 
antitoxin. Morphine, chloral, etc., were also used. Case 2. — Girl» 
aet. 22, splinter under nail. Symptoms on 9th day, disease marked in 
6 days. Splinter removed and used to inoculate mouse, which died of 
tetanus in 24 hours. Large doses of Behring's serum were used. Case 
3.— xt. 21. Six days after onset patient presented appearance of very 
severe case of tetanus. Injections on 13 days. Engelmann gives in 
detail 34 recorded cases treated by Tizzoni-Cattani*s antitoxin, among 
which were many unfavorable cases. In 17, incubation period was 
from I to 10 days and only 5 died, the usual mortality in such cases 
being 90 per cent. 

In cases over 10 days the prognosis was more favorable, but in 
several the rapid development of the symptoms showed the disease to 
be very serious. In 21 cases improvement rapidly followed the serum 
treatment but in 3 it was only temporary. In 5 cases was there no 
improvement and these ended in death. Thus, in 36 cases In alU 
treated by this serum, only 8 ended fatally. Of these, 3 were compli- 
cated by septic processes and 4 had insufficient doses, the remaining 
cases dying a few hours after coming under treatment. The author 
also analyses 18 cases treated by Behring's serum. He concludes that 
both Tizzoni-Cattani's and Beh rings serum can favorably influence the 



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124 

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all well-marked 

re is pain, tender- 

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>n. In mild cases, if 

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and if all the symptoms 

urges operation strongly. 

pressed the belief that the 

ar in the direction of opera- 

NK.— In the same No., Brit, 

"ssful removal of an enormons 

11 pounds. The intestines were 

to the tumor that it was necessary 

.e gut (about 8 feet). The patient 

is successfully removed 330 centime- 

that the removal of 286 centimetres of 

led. Journal, No. 1 ,930, Bemhard (quoted 

en, Nov. 23, 1897) relates a successful case 

ined for rupture of the spleen without external 

<^es have been recorded for various causes. 



126 MEDICAL SOCIETY OF NEW JERSEY. 

disease; that large doses are harmless; that it is desirable to use 
them early in doses corresponding to the severity of the disease and 
that, finally, no distinction can really be made between the two serums. 

In No. 191 9, British Medical Journal, Bernard Roth. F.R.C.S.. 
gives statistics of i .000 cases of Lateral Curvature of the Spine 
treated by him by posture and exercise. Eight hundred and sixty-nine 
were •* very much improved " and 75 " improved.*' Of these. 207 re- 
tained the good results three years afterwards. 

Early Nervous Symptoms of Pott's Disease. — In the 
Journal de Medecine, ]\x\y 10. 1897, Gragnot has collected a series 
of obsevations of considerable importance on various early symptoms 
of Pott's disease. The painful symptoms of the early period are very 
variable and seldom referred to the spinal column. They consist of 
radiating pains, following the course of a nerve trunk, in the neck, 
thorax, abdomen, upper or lower extremity, and are characterized by 
sensations of constriction, burning, tearing or stinging. They are apt 
to alter in position ; thus, intercostal pain on one side, which might be 
confounded with other conditions, more particularly pleuritic, if appear- 
ing on the other side in corresponding position, will give an indication 
of its probable nature. So of sciatic pain. More difficult are certain 
superficial or deep localized areas of pain, which do not correspond with 
any particular nerve disturbances and which may be situated in any part 
of the trunk, In character they are dull, indefinite and may be erratic 
in duration. Sometimes arthralgia appears suddenly, especially in the 
knee. An important fact is that these pseudo-neuralgic pains are 
more common in adults than in children. It is not uncommon to find 
these pains accompanied by muscle wasting. There may be also 
motor symptoms in addition, as paralysis of irregular distribution in 
the limbs. 

Forced Reduction of Lateral Curvature of the Spine. 
— In the British Mid. Journal, No. 1.932. Noble Smith. Senior Sur- 
geon to City Othopedic Hospital. London, reports a case with illustra- 
tions, in which he had tried forced reduction in a very marked case of 
lateral curvature. Three weeks after commencing treatment there was 
a very appreciable lessening of the deformity. 

Nerve Suture (Arch. f. Klin. Chirurg., Vol. liv., p. 171).— C. 
Sick and A. Saenger relate a case of paralysis of musculo-spiral ner\'e. 
successfully treated by suture of peripheral end of musculo-spiral 
to the median. Patient was a boy. aged 5. The wound of nerve 



APPENDIX TO THE MINUTES. 12/ 

accompanied a fracture. Two years after operation the paralysis had 
almost entirely disappeared. 

As regards Appendicitis, conservatism has somewhat modified the 
tendency to immediate operation. There is today a preference for 
operation after inflammatory action has ceased, and the con- 
sensus of opinion seems to be increasing in favor of operation 
after second attack. But in the border-line cases the dictum 
may be formulated, "when in doubt, operate." As reported in 
No. 1,919, of the Brit, Med, Journal, G. E. Armstrong, M. D., Sur- 
geon Montreal General Hospital, opened the discussion on appendi- 
citis, before the last meeting of the British Medical Association. 
He stated that of the 517 cases treated in three hospitals of Montreal 
since 1889. there was a mortality of 12.8 per cent. Three hundred 
and eighty-nine were operated on and 128 treated without operation. 
Of these latter, 4 died (3.12 per cent), death being due to septic peri- 
tonitis. Of the 389 cases operated on. 84 were interval cases with no 
deaths ; 305 in the acute stage with 65 deaths, a percentage of 20.65. 

Dr. Armstrong's working rule is to operate on all well-marked 
cases at once. This includes all cases in which there is pain, tender- 
ness, muscular rigidity with vomiting, elevations of temperature, 
acceleration of pulse and a serious facial expression. In mild cases, if 
at the end of 24 or 36 hours he is not perfectly satisfied that the con- 
dition of the patient is undoubtedly improving, and if all the symptoms 
are not decidedly less on the third day, he urges operation strongly. 
In the discussion Sir William Kingston expressed the belief that the 
pendulum had been violently swung too far in the direction of opera- 
tive procedure. 

Extensive Excision of Intestine.— In the same No., Brit. 
Med, Journal^ is recorded the successful removal of an enormons 
mesenteric tumor, weighing thirteen pounds. The intestines were 
found to be so intimately adherent to the tumor that it was necessary 
to remove 234 centimetres of the gut (about 8 feet). The patient 
recovered. Ruggi, of Rome, has successfully removed 330 centime- 
tres. It has been concluded that the removal of 286 centimetres of 
intestine is feasible. 

In the Epitome, Brit, Med, Journal, No. i ,930, Bemhard (quoted 
from Munch Med. Woe hen, Nov. 23, 1897) relates a successful case 
of Splenectomy performed for rupture of the spleen without external 
Avound. Some 160 cases have been recorded for various causes. 



128 MEDICAL SOCIETY OF NEW JERSEY. 

The mortality has been 89 per cent, in cases of leukaemia and 36 per 
cent, in other cases. In 28 cases the spleen was ruptured and pro- 
lapsed into the wound, and here operation was successful. There are 
only 6 cases on record in which the operation has been done for rup- 
ture without external wound, and 5 of these died. The author's 
case was that of a boy 19 years old, over whom a wagon had passed. 
Shortly after, marked anemia, collapse, nausea, retention of urine, etc., 
were noted. There was dullness in the most dependent portions of 
the abdomen and over the left hypochondrium A correct diagnosis 
was made and splenectomy performed. Intravenous transfusion was 
done before the operation, and canula left in situ during the operation. 
Recovery, as far as anemia was concerned, was prolonged. 

Drainage of Large Cavities. -In Brit. Med. Journal, No. 
i»934i George Heaton, M.B., F.R.C.S., Surgeon, General Hospital, 
Birmingham, publishes a note on syphon drainage by means of a 
reservoir, a bit of tubing, a glass Sprengel pump and a tube connect- 
ing the pump with the glass drainage tube of the cavity to be drained. 
The chief difficulty was found to be with the drainage tube. When 
an ordinary piece of glass tubing or a Keith's drainage tube with per- 
forated sides was used, the action was so strong that the walls of the 
cavity to be drained were sucked into the openings, giving the 
patient pain and putting an end to syphon action. These disadvan- 
tages were obviated by having two tubes, an outer one perforated at 
the sides, which encloses an inner one that is connected with 
the pump. 

Dr. Heaton mentions a case of destruction of the spinal cord, in 
which a cystitis was set up with dribbling of urine. To relieve this 
a supra-pubic cystotomy was done, and drainage established by the 
device above mentioned. The patient has now had his bladder 
drained for a period of five months. During this time the bed-sores» 
relieved from the irritation of dribbling urine, have healed. The cost 
of the apparatus is insignificant. 

The Surgery of Chronic Peritonitis. — In the Epitome, Brit^ 
isk Medical Journal, Feb. 5, 1898, Largeau {Progrks Medical^ Nov. 
27, 1897) advocates abdominal section for chronic peritonitis of the 
perihepatic, perigastric, pericoccal, pericystic, pelvic and, above all, 
traumatic or port-operative types. It often happens that the setting 
free of adherent structures, or the division of a band of organized 
lymph, causes the immediate disappearance of gastric or gastro- 



APPENDIX TO THE MINUTES. 1 29 

intestinal disturbance and chronic obstruction. In chronic tuberculous 
peritonitis the case is different. Care must be taken that the disease 
is not assuming a temporarily acute form when the abdomen is 
opened. It is true that mere explorations have given good results 
after all forms, but Largeau admits that when there is ulceration the 
progress is bad. In the ascitic and the dry form of tuberculous peri- 
tonitis, abdominal section is alike satisfactory. A small abdominal 
wound should be made first and the deeper tissues divided with great 
care as intestine is often adherent, and the diseased peritoneum is not 
always easy to distinguish. In a female subject the lower end of the 
incision should be brought far down, so that the pelvic structures 
should be explored ; in fact, tuberculous appendages, often the primary 
cause of the whole trouble, may require removal. The main part of 
the whole operation is thorough drying of the exposed cavity with 
tine sponges or compresses. Not only Douglass' pouch must be so 
treated, but care must be taken to dry all diseased peritoneum lying 
under coils of intestine. Hence, the operation always takes some 
time to do properly. Only soft adhesions between the intestines 
should be separated. Whilst the drying process is the essential 
feature, the surgeon must never fail to seek for the primary seat of 
the disease. The chances are very great that in a female subject the 
fallopian tubes are at fault. But in women, as in all male cases, the 
caecum and appendix must be searched, and tuberculous disease of 
the omentum — very common as a secondary complication — or an 
ulcerating area beginning in the small or large intestine, looked 
for. The last complication is the gravest; when detected, pus is 
generally present around the breach in the intestinal wall. This pus 
must be washed away. Drainage is compulsory. Lastly, in the 
purely dry form of tuberculous peritonitis, separation of the adhesions 
often proves very satisfactory, as they are firm in this type and give 
rise to obstruction. Washing out with chemical solutions or flushing 
the peritoneum seems superfluous, and drainage is only needed when 
the intestine is ulcerated. It is very important to close the abdominal 
wound carefully. 

In the London Lancet^ No. 3898. Mr. Mayo Robson. F.R.C.S., con- 
tributes a paper on " A Method of Exposing and Operating ok 
THE Kidney without the Division of Vessels or Nerves." 
Mr. Robson says the late Greig Smith insisted on the importance of 
opening the abdomen in the course of the muscular fibres as much as 



I30 MEDICAL SOCIETY OF NEW JERSEY. 

possible, so as to avoid the weakness that is apt to follow division of 
muscle. Mr. Robson is not aware that Greig Smith ever explored the 
kidney in this manner. Dr. McBurney's method of operating for appen- 
dectomy suggested to his mind the idea of exploring the kidney in a 
similar manner. After performing a number of operations by this 
method, his attention was called to a paper of Dr. Abbe's in ihe 
Transactions of the New York Surgical Society, in which he describes 
a nephrectomy performed on the same principle. Mr. Robson has 
found the operation of great utility and recommends it to other 
surgeons. The incision beginning at the inner side of the anterior 
superior spine of the ilium is carried backwards obliquely towards the 
top of the last rib ; the fibres of the external oblique and its aponeur- 
osis are then split and retracted, exposing the internal oblique, the 
muscular fasciculi of which are split in a line between the ninth costal 
cartilage and the posterior superior spine of the ilium, in which 
position they are larger than in front or behind that line. When the 
fingers are pushed through the internal oblique to split it, the fibres 
of the transversalis are pierced and can be extracted along with the 
oblique muscle. A diamond space is thus formed, at the bottom of 
which is seen the transversalis fascia. This is then incised, exposing 
the perirenal fat, and on pushing the fingers through this the kidney 
is easily reached, in whatever position it may lie. If needful, the 
whole hand may be introduced into the perirenal space and the kidney 
can be grasped and freely manipulated, the retractors being withdrawn 
for the moment. If the cases are moderately long and in all cases of 
movable kidney, the organ may be brought through the wound and, 
if necessary, examined by the selenium screen and the Roentgen rays. 
Should a calculus be found it may be extracted and the wound 
sutured before the organ is returned. Mr. Robson gives brief histories 
of a number of cases, of which No. i gave the following result : On 
February ii, 1898, the above-described operation was performed on 
a woman of 69 years. Four stones were extracted from a dilated 
kidney, together with a quantity of pus. Drainage was effected 
through a stab-wound in the loin and the original wound was closed. 
The wound healed by first intention and the tube was removed in a 
week. She was an out-patient on March i , and was shown at the 
clinical meeting of the Society on March 4. This result is not 
exceptional. The advantages of the operation are : i — No weaken- 
ing of the abdominal wall. 2 — No vessels arc divided. 3 — No nerves 



APPENDIX TO THE MINUTES. I3I 

are severed and therefore paralysis of the rectum and other muscles 
is avoided. 4 — The operation is done without the patient lying on 
the back, to the great convenience of the anesthetist, the operator 
and his assistants, and to the manifest advantage of the patient. 5 — 
The saving of time and avoidance of hemorrhage means lessening of 
shock, thus rendering the operation feasible when it might otherwise 
be questionable. 6 — It is an important fact that diagnosis in kidney 
cases, especially in renal calculus, is by no means perfect, and if it 
can be proved that an exploration of the kidney can be done quickly, 
with little or no danger and without any subsequent weakness being 
left, there will be less reason for avoiding exploratory operations. 
7 — Convalescence is materially shortened. 

BoRACic Acid and Salol in Cystitis.— In the Lancet is a 
note of cystitis following supra-pubic lithotomy in a man of 83. 
Arthur H. Buck, F.R.C.S., of Brighton, contributes the article. 
Cystitis was present before the operation, and in spite of washing out 
the bladder three or four times every day there were bacteria in 
freshly drawn urine three weeks after the operation. The urine was 
of a dull light yellow color and was becoming alkaline. It varied in 
quantity from three to five pints. On the twenty-second day ten 
grains of boracic acid and three grains of salol were prescribed every 
four hours. Within two days the urine was acid and in a fortnight it 
had regained its normal characteristics, no albumin being present and 
no bacteria. 

Danger of Aspirating the Liver.— In Indian Medical 
Gazette, April, 1898, quoted in the Lancet, Surgeon Lieut.-Col. Hatch 
contributes an important paper in which he relates cases of fatal 
hemorrhage following aspiration in suspected abscess of the liver. 
In one case an autopsy showed the abdomen filled with blood and 
great blanching of the body. There was no abscess of the liver. In 
a sixth case an intercostal artery was nicked and gradual hemorrhage 
into an abscess cavity took place and proved fatal. The operation 
offers no compensatory advantages for the undoubted risks. 

Hemorrhagic Infarction of Small Intestine. — Lancet, 
April 30, 1898. At a meeting of the surgical section of the Royal 
Academy of Medicine of Ireland, held April i, 1898, Mr. Gordon 
read a paper on a case of ** Hemorrhagic Infarction of the Small 
Intestine," which he had treated by resection. The leading symptoms 
were: 1 — Sudden onset, marked by severe abdominal pain. 2. — 



132 MEDICAL SOCIETY OF NEW JERSEY. 

Vomiting. 3 — Prostration bordering on collapse. 4 — A tumor formed 
by a distended coil of gut easily palpated in the right iliac region. 
There was no general abdominal distension. Operation was per- 
fonned in 24 hours after onset. Much bloody fluid was found in the 
abdomen and the coil of distended bowel was black. Two feet of 
small intestine were resected, together with an area of mesentery. 
The ends of the gut were united over a bone bobbin. An intestinal 
fistula formed ten days later but had completely closed at the end of 
three weeks from date of operation. This was in August, 1897, and 
up to the present time there has been no evidence of trouble. 

Symmetrical Gangrene from Embolism of one Iliac 
Artery (quoted in the Lancef). — At a recent meeting of the Society 
Medicate des Hopitaux, M. Widal and M. Nobecourt brought for- 
ward a case of symmeterical gangrene, produced by embolism of one 
iliac artery, a result which, though anticipated theoretically by some 
writers, does not appear to have been personally observed. A man, 
45, suddenly had symptoms of commencing gangrene of left leg. In 
6 days there was slight tenderness in the course of the femoral artery 
in the triangle of Scarpa, and no pulsation could be felt. The pulsa- 
tions of the right femoral were quite distinct. Six days after the onset 
of the symptoms the right leg became affected. Eighteen days after 
the onset of the symptoms pulsations returned in the right femoraL 
The gangrenous changes progressed in the left limb but were arrested 
in the right, a little below the patella. The patient died on the 28th day. 
In the left common iliac artery was an embolus adherent to the inter- 
nal coat, which appeared normal. Secondary but non-adherent clots 
were prolonged downward into the internal and external iliacs, the 
femoral and the deep femoral arteries. A secondary clot ascended to 
the bifurcation of the aorta and then descended into the right iliac 
and femoral arteries. All the secondary clots were soft and non- 
adherent, those in the right side especially, floated in the arteries 
which they did not All. The left kidney and the spleen were full of 
infarcts of the same nature as the iliac embolus. 

Osteotomy of the Femur as a Treatment for Tuber- 
culous Disease of the Hip in its Early Stages. — Lancet^ 
April 9, 1898, R. F. Tobin, Surgeon to St. Vincent's Hospital, Dublin, 
contributes a paper on this subject, the following being one of the 
cases cited : A delicate boy of 10 was exhibited to the Royal 
Academy of Medicine of Ireland, on Mar. 14, 1898. He had been 



APPENDIX TO THE MINUTES. 133 

admitted into St. Vincent's Hospital Jan. 14, 1898, suffering from well 
marked tuberculous disease of the left hip. Flexion adduction and 
apparent shortening were very pronounced. Pain was complained of 
in the hip and knee. The joint was full and tender and apparently 
fixed, but under chloroform the head of the bone was movable and 
could be pressed down into the acetabulum with obliteration of what 
was a striking feature of the case, prominence of the hip. On the 19th, 
osteotomy was performed, dividing the bone obliquely from the 
greater to the lesser trochanter and putting the limb straight. Sub- 
sequently to the operation the patient progressed favorably, there be- 
ing no pain nor rise of temperature. Five weeks after the operation 
the splint was removed. The fracture was found to be firmly united, 
the limb was in good position, the fullness in the joint was only just 
appreciable and there was no pain. Since then he has been going 
about the wards wearing a Thomas's splint. Mr. Tobin gives results 
in five other patients, the only ones he had treated by osteotomy. In 
every instance complete union of the fracture had taken place within 
six weeks, with little or no pain or other disturbance. In every in- 
stance the progress of the disease was arrested, as instanced by the 
subsidence of the swelling and the non-formation of abscess, and in 
every instance a fairly rapid recovery has ensued and a straight useful 
limb has either resulted, or, in very recent cases, promises to result. 
The operative procedure is still subjudice. 

Rectangular Splint after Removal of Breast. — Lancet, 
Feb. 5, 1898, Edward Cotterel, Surgeon to the Cancer Hospital, 
London, contributes a diagram of a rectangular splint o( wire, with 
a movable joint for treating cases after amputation of the breast. 
He speaks of the discomfort and pain experienced by patient, and 
after wound has healed, the movements of the shoulder are generally 
very limited and painful. On November 8, 1897, he showed at the 
Medical Society of London, a patient 16 days after the removal of the 
breast, steno-costal part of pectorales major and axillary glands, to 
demonstrate the very great advantages of keeping the arm at a right 
angle to the body instead of across the chest, as is the usual practice. 
The advantages of the splint are, (i) it is most comfortable to the 
patient, the forearm and hand are free and there is no cramp nor 
stiffness of the elbow, wrist or fingers ; (2) when the splint is removed 
there is no stiffness of the shoulder, the patient being able within a 
fortnight to dress her back hair and hook her dress ; (3) requisite 



134 MEDICAL SOCIETY OF NEW JERSEY. 

pressure can be maintained to keep the surfaces of the wound in con- 
tact ; (4) when much skin has been removed, should the position of 
abduction cause too much tension upon the stitches* the arm can be 
bi-ought forward and so relax the pans by altering the joint of the 
splint to the required angle. 

In the Lancet ^ March 5, 1898, Priestley Leech, M.D., F.R.C.S., has 
a communication in which he speaks of his method of preventing 
stiffness and discomfort after breast operations. Having seen Mr. 
Cotterel's suggestion of a splint, in a subsequent case he bandaged the 
chest with a many-tailed bandage but kept the arm at a right angle to 
the body and let it lie on a pillow, encircled with a broad ring made 
from a pillow case, the two ends being fastened with strong safety 
pins to the head of the bed. The result was all that could be desired ; 
the wound healed by first intention and the patient was able to do her 
hair at the end of a fortnight. This plan was also successful in two 
other cases* 

ECHiNOCCus OF Both Lungs Treated Surgically.— Epi- 
tome, Brit, Med, Journal, (quoted from Centralbl, f. Ckiru^g,^ No. 
I, 1898). Steiner relates a successful case with very severe symp- 
toms. The patient had signs of liver and lung disease. Heart was 
displaced to right and when mouth was opened a buzzing noise was 
heard, synchronous with the heart sounds. On puncture of left side 
of the thorax posteriorly, fluid containing booklets was withdrawn. 
A year and a half before this report, Prof. Israel opened over the 
hepatic swelling, incised a large hydatid cyst, fixing its edges to the 
abdominal wound and then found a second sac behind it. This was 
opened and the subphrenic space discovered posteriorly. Seventh 
and eight rib were resected behind, the costal and pulmonary layers 
of the pleura united by a circle of sutures and the lung laid 
open within the circle. A hydatid as big as a human bladder was 
removed, lung immediately filling its space. At once the buzzing 
noise caused by pressure of the cyst on the pericardium disappeared. 
Six weeks after there were pricking pains and dullness at the right 
base. On puncture, hydatid fluid escaped ; dyspnoea followed until 
the patient coughed up much hydatid fluid. Later on, chronic broncho- 
pneumonia developed. On recovery it appeared that the echinoccus 
had atrophied and come away. The patient is now well. The right 
thorax which had been treated by nothing more radical than puncture, 
was somewhat diminished in capacity, whilst the left, where resection 



APPENDIX TO THE MINUTES. 1 35 

and removal of an hydatid had been successfully undertaken, remained 
of normal capacity. 

Penetrating Wounds of Heart. — In British Medical Journal, 
No. 1924. is contained an excerpt from Georg. Med. del Regio Esercito 
Au. 15, N. 8, 9, in which Faralli and Ragnini report the case of a man, 37, 
who received two knife wounds on July 7, 1895, one in the fourth left 
intercostal space and the other under the costal arch of the same side. 
From the upper wound he lost much blood and was unconscious for 
three hours. The wound was dressed and patient went on well until 
the sixth day. when he was seized with an attack of faintness and 
sweating and loss of consciousness. He left hospital on the forty- 
fifth day apparently cured, but faintness recurred on every strong 
exertion. Four months later abdomen began to swell, and in Febru- 
ary, 1896, paracentesis was performed and repeated seventeen times. 
On admission to hospital in March a double cardiac impulse was 
noted, one in the fourth interspace immediately below the nipple, the 
other in the third space, four cm. from sternal line. The beats were 
not synchronous. There was a double thrill and murmur. In April, 
patient had pneumonia; in May, peritonitis, for which laparotomy 
was performed on the twenty-fourth, and patient died June 4. At the 
necropsy the heart was found adherent all around to pericardium. 
There was a cicatrix in the anterior wall of the right ventricle, one 
cm. from interventricular septum, and an open communication 
between the two ventricles, having fibrinous deposit on the edges of 
the orifice. During life, patient had no cyanosis. 

Treatment of Hemorrhoids by Injection.— ^r/'/Wift Medical 
Journal, No. 1932, (abstract from South Russian Medical Journal^ 
S. J. Shalecta, a surgeon of the Kief Jewish Hospital, uses a modified 
solution of carbolic acid for injection into hemorrhoids. In external 
piles he uses a mixture of carbolic acid, pure, two parts, with one part 
of two per cent, solution of cocaine, introduced through the mucous 
membrane and not through the skin. The results in sixty-nine cases 
were most satisfactory. Absence of pain, no necessity for anesthesia, 
little risk of suppression of urine, no loss of blood, no need to keep the 
bowels quiet, are among the advantages claimed. 

Duration of Contagion of Syphilis.— Campana (// Poll- 
clinico, July, 1897, British Medical Journal, No. 1923) concludes that 
it is not easy to define the duration of the contagion, but in any case 
it is probably longer than is commonly taught. Even tertiary mani- 



136 MEDICAL SOCIETY OF NEW JERSEY. 

festations may be contagious at the beginning. The duration is in 
relation to the duration of vascular irritative manifestations and in 
proportion to these. As long as there are any papular exudative 
manifestations, contagion certainly exists. 

Protargol in Acute Gonorrhgea.— ^r//Wi4 Medical Journal^ 
No. 1928. Neisscr, in CentralbL f. Dermatologies October, 1897, 
regards the ideal treatment of acute gonorrhoea as one by which the 
gonococci are killed without the mucous membrane being affected or 
the inflammation or suppuration increased. The best method is by 
injection. The best substance for this purpose in protargol, a proteid 
silver-containing compound. It may be used in solutions up to one 
per cent, without causing irritation. 

Periosteal Abscess caused by Typhoid ^kqwaa,— British 
Medical Journal, January 22, 1898. At a meeting of the Birmingham 
and Midland Counties branch, Mr. Barling read a note of this case 
admitted to General Hospital June 29, 1897. The patient, a girl of 
16, had a painful swelling of the left • forearm. She had had typhoid 
fever three and one-half years before, following which she had pain in 
the left forearm, but there was no formation of abscess. Some 
peculiarities of the case suggested a specific inflammation and the 
patient was treated for six days with iodide of potassium. The 
inflammatory signs becoming worse, the swelling was incised. Several 
drachms of pus were evacuated and a small sequestrum removed. A 
cultivation of the pus was made with the usual precautions on Agar 
Agar. This proved to be a pure culture of the bacillus typho-abdo- 
minalis. A culture of the bacillus was sent to Dr. Durham, at 
Cambridge. He examined it and came to the conclusion that it was 
the bacillus typho-abdominalis. 

Treatment of Inoperable Sarcoma by Coley's Fluid. — 
British Medical Journal, No. 1938. At a meeting of the Harveian 
Society, London, Mr. Mansell Moullin read a paper upon the treat- 
ment of inoperable sarcoma by Coley's fiuid. He gave details of ten 
cases. In three the tumors had disappeared and had not recurred. 
He also gave details of cases in which malignant growths had dis- 
appeared after attacks of erysipelas. 

At a meeting of the Medical Society of London, held April 4, 1898, 
Mr. W. H. Battle showed a case illustrating the advantage of Coley's 
fluid in the treatment of inoperable tumors. The man was 30, a 
patient in St. Thomas' Hospital, admitted December 31, 1897. He 



APPENDIX TO THE MINUTES. 1 37 

had had syphilis six years before. There were numerous fluctuating- 
tumors above the clavicle and in the axillary space. Iodide of potas- 
sium had no appreciable effect. Pieces were removed and examined 
by Mr. Shattuck and Dr. Jenner, who both reported that they were 
sections from a fibro-sarcoma and contained numerous giant cells. 
Coley's fluid was injected. The tumors were greatly reduced in size» 
one large one having become scarcely appreciable. 

Myeloid Sarcoma of Femur treated by Scraping.— -^r//«^ 
Medical Journal^ No. 1939. To this journal Frank Hinds, M.D., 
Worthing Infirmary, contributes the history of a case of a wheel- 
wright, 34. admitted to hospital in June, 1895. He had aching pains 
about right knee which had continued for fifteen months. The knee 
was. larger than the other. He could get about and do his work. He 
was healthy looking. Femur was enlarged in direction of inner 
tuberosity. Operation revealed a thin expanded condition of bone. 
A thin shell was taken out and the growth removed with sharp spoon. 
There was much bleeding. A cavity was left involving both condyles, 
extending upwards into the shaft, measuring four inches from the 
opening in internal tuberosity to outer side. The surface of it was 
scrubbed with chloride of zinc solution (gr. xx to ^j.), and packed 
with cyanide gauze. At the end of six weeks the granulations at 
wound not being satisfactory, cavity was again scraped and scrubbed 
with zinc solution. Convalescence was uninterrupted. At present, 
health is perfect. The knee has only a very slight degree of flexion. 
The growth was a myeloid sarcoma with very numerous giant cells. 

Recurrent Carcinoma of.the Breast treated by Thyroid 
Extract. — Lancet, May 28, 1898. In December, 1895, Frederick 
Page M.D., F.R.C.S., surgeon to Royal Infirmary, Newcastle-upon- 
Tyne, saw a woman, 61, who was suffering with carcinoma of left 
breast of six months duration. General heahh was very much 
impaired. Growth was situated in upper part of breast and both the 
axillary glands and their lymphatics were involved. In January, 1896, 
the breast and glands and lymphatics were removed, with the axillary 
fat and the pectoral fascia. In April following there was a recurrence 
in the cicatrix ; July 18, several nodules were removed. A portion of 
these growths was sent to the Clinical Research Association. The 
report was, '* Both specimens show a soft carcinomatous growth with 
small alveoli and very scanty stroma, etc " Three weeks afterwards 
other nodules appeared and later a group developed in the subcutane- 



138 MEDICAL SOCIETY OF NEW JERSEY. 

ous fat. In September. 1896, thyroid extract was given, at first three 
grains daily. The dose was gradually increased till fifteen grains 
could be taken daily. During the eighteen months that the treatment 
was persistently followed, it was found necessary occasionally to 
suspend the use of the drug for some days on account of its toxic 
effect. The patient is now quite well ; she has gained fiesh and health. 
There is no trace of the disease to be discovered. The treatment was 
suggested by reading Dr. Beaston's papers in the Lancet of July 1 1 
and 18, 1896, in which he maintains that the results are dependent on 
a previous oophorectomy. This case was after the menopause. 

Lancet^ June 11, 1898, G. Ernest Hermann, M.D., F.R.C.P., etc., 
obstetric physician to London Hospital, reports a case in which the 
mamma was removed by Mr. Frederick Treves, in October, 1896. In 
December following she noticed a lump in the armpit and above the 
clavicle. Operation was attempted but the growths were found to 
be impossible of removal. March, 1897, both ovaries were removed 
and as soon as possible the patient was given thyroid extract. She 
has taken this in as full doses as she could, varying from ten to fifteen 
grains daily. On September 27, 1897, she was examined by Mr. 
Treves and Dr. Hermann. The supra-clavicular growth was no 
longer to be felt. The axillary artery could be felt pulsating, ap- 
parently quite free from any growth around it. May 5, 1898, the 
patient was seen by Dr. G. C. Taylor, of Trowbridge, who reported, 
'* I examined the operation scars this day and find that they are 
pale, almost the color of the surrounding skin ; soft, no adhesions to 
the subjacent parts and no deposits* of any kind in the surrounding 
tissues." The patient has gained considerable weight. 

Treatment of Backward Dislocation of Thumb.— ^r///j^ 
Medical Journal, No. 1932. Jonathan Hutchinson, Jr., communi- 
cates remarks on this subject and adduces the following propositions: 
I — In backward dislocations of the first thumb-phalanx a careful trial 
should be given to the manipulation method described by M. Fara- 
bouef and others. 2 — If this fail, a tenotome should be introduced 
from the dorsum behind the projecting base of the phalanx, so as to 
divide the glenoid ligament and allow the sesamoid bones to slip on 
either side of the metacarpal head. 3.— This divides no important 
structure, is perfectly safe if done antiseptically. No palmar incision 
should ever be made. The difficulties in the dislocation are generally 
in the glenoid fibro-cartilage and the sesamoid bones which are 



APPENDIX TO THE MINUTES. 1 39 

■developed in it. The fibro-cartilage is very strong, and Hutchinson 
•doubts if the transverse fibres are ever torn in a backward dislocation. 

The Fate of Bone Implanted after Trephining.— ^r//wA 
Medical Journal, No. 1937. C. Mansell MouUin, M.D., F.R.C.S., 
-surgeon to London Hospital, contributes the history of a case of a 
sailor who had, in 1894, after a fall, a severe injury to the left parietal 
region with localizing symptonns. For this he was operated on in 
April, 1896. The paralysis and aphasia improved and the fits ceased 
for a time. In February, 1897, the fits recommenced, at first only 
two or three a week, but latterly as many as one or two each day. 
There was a large semicircular scar over left parietal region. The 
bone had been removed over an area the size of the palm of the hand 
and the fragments of bone afterwards replaced. Two spots were 
especially tender, one about the centre of the scar, the other at the 
posterior extremity of the scar. Any pressure on the tender spots or 
any sudden emotion would produce a fit. The fits begun with a 
-feeling of pressure and pain on the top of the head. The scalp was 
reflected in approximately the same area as before. The dura mater 
was found to be covered with a mosaic of bone fragments, each about 
three-quarters of an inch in breadth and one-half inch in width. 
They were slightly adherent to scalp above and to dura mater beneath, 
but could be easily detached. In the centre, corresponding to point of 
tenderness, one fragment of bone had slipped beneath another, and 
the underlying one had grown out into an irregular toothed projection 
of intensely hard bone, as large as a small pea. This fitted into a 
little pit in the dura mater which here was very much thickened and 
condensed. The rest of the mosaic was not interfered with and the 
-scalp was laid down again to cover it in. The patient recovered with- 
out a bad symptom, and during the six weeks he remained under 
observation no more fits occurred. 

Severe Compound Fracture of Radius and Ulna with 
Avulsion of the Flexor Muscles in the Forearm.— Z^«- 
•cet. No. 3.884. A man, 21 years old. was admitted to Manchester 
Royal Infirmary, Sept. 13, 1897, with a compound fracture of both 
bones of the right forearm, and a mass of muscles and tendons hang- 
ing out of a transverse wound of the flexor surface of the limb, due 
to a pulley accident. The bones were broken rather below the middle 
of the forearm and the proximal part of the radius projected about one- 
half inch from a lacerated transverse wound of the limb. The wound 



I40 MEDICAL SOCIETY OF NEW JERSEY, 

was four and one-half inches long and hanging from it were the 
flexor carpi radialis, palmaris longus and part of the flexor sublimis 
digit orum, all torn away about two inches from their origin at the 
condyle of the humerus but preserving the distal attachments. The 
median nerve was torn across above and was coiled up near the 
wound of the skin. The radial and ulnar arteries were intact. Mr. 
Ray decided to attempt to save the limb. He made an incision on 
the front of the forearm, from a point about two inches below the 
elbow to the lacerated wound mentioned above, and also for a short 
distance towards the wrist. He found the pronator radii teres was 
partially divided, as well as the deep flexor muscles of the forearm, 
whilst the median nerve was divided about an inch after passing be- 
tween the heads of the pronator radii teres. About three-quarters of 
an inch of the radius was removed on the prominal side and Mr. 
Ray sutured the median nerve, pronator radii teres and the deep- 
flexors and replaced the muscles that had been torn from the region of 
the elbow, viz., part of the flexor sublimis digitorum, the palmaris 
longus, the flexor carpi radialis. The nerve was sutured with fine 
silk and the muscles with medium-sized catgut. The aponeurotic in- 
vestment of the front of the forearm was next brought together with 
a continuous catgut suture, and a silkworm-gut was used for the skin. 
Dry dressings were applied and the limb (the elbow flexed and fore- 
arm semi-pronated) was placed on an internal angular splint and was 
not looked at for ten days, when everything was healed with the ex- 
ception of the meeting of the skin incisions with the lacerated wound. 
Firm union has taken place in both xadius and ulna and he can flex 
and extend the limb through fully 90®, and has the same power of 
rotation and supination. The replaced muscles are again active 
and flexion of the digits is easily performed, whilst sensation over the 
middle nerve area is normal. 

The Setting Time of Plaster of Paris. — In the issue of 
Treatment for March 24, 1898, Mr. D'Arcy Power and Mr. J. A. 
Belcher publish details of a number of experiments made for the pur- 
pose af ascertaining what effects various substances in solution have 
upon the setting time of plaster of Paris. They find that where it is 
of importance to make plaster of Paris set rapidly, it should be mixed 
with a five per cent, solution of common salt, and this may be made 
roughly by adding a tablespoon ful of salt to a pint of water. 



APPENDIX TO THE MINUTES. I4I 

Paper read by E. Fayette Smith. M.D., Newark, 

N. J., ON '* The Year's Progress in Diseases 

OF THE Nose and Throat." 

The voluminous literal ure of the year records no striking discover- 
ies in diseases of the nose and throat, nor in the method of treatment, 
yet it is clearly observable that there has been an appreciable progress 
in our understanding of the common and well-known maladies of 
these regions, in operative technique, and a distinct advance in our 
knowledge of some of the more obscure pathological conditions. The 
purpose of this brief report may best be fulfilled, I think, by a general 
review of the field in which something like real and permanent pro- 
cess has been made, rather than by detailing isolated cases although 
of dramatic interest, or ingenious remedial experiments which have 
given no promise of withstanding the test of time. A number of 
papers have recently appeared giving remarkably successful results 
obtained in operations for laryngeal cancer, notably those by Semon 
and Frankel, who employed both intra and extra laryngeal methods. 
The field is too vast for more than this passing reference to these 
brilliant records, but one who reads them in their entirety will perceive 
that with exception of intubation, they show the greatest advance 
made in years in laryngeal surgery. 

The relation of adenoid growth to deaf^mutism. This extremely 
interesting theme has received considerable attention during the year» 
particularly from Dr. Ottaker, of Prague, and Dr. Zendziak, of War- 
saw. The former, in an extended series of cas^s observed in a deaf 
and dumb institute, found adenoids in 59.49 per cent, of boys and 
girls who were deaf and dumb. He says : *' This remarkable fre- 
quency of adenoid growths in deaf mutes is certainly not accidental, 
but it must be considered with great probability that they stand in 
some causal relationship to deaf-mutism." 

From Dr. Zendziak's paper I condense the following case : G., a 
five year old boy, was sent me by one of my colleagues on account of 
congenital deaf-mutism. On interrogation of the child's mother, I 
learned that her twenty year old son was also deaf and dumb from 
birth ; a daughter was also deaf and dumb, and died when four years 
old. On examination I convinced myself that the child could neither 
hear nor speak. Instead of speech there was a kind of stuttering 
impossible to understand. The boy was physically fairly well devel« 



142 MEDICAL SOCIETY OF NEW JERSEY. 

oped. In the naso-pharyngeal cavity I found by palpation enormous 
quantities of adenoid vegetations ; in the ears, retraction of tympanic 
membranes. Without promising the parents an absolutely favorable 
result, I proposed an operation, which was performed under chloroform 
by forceps and Gottstein's curette. After three months the boy was 
brought to me, and the mother told me with great joy, that immedi- 
ately after operation the hearing improved, and within a week the child 
began to pronounce, at first, single words, later whole sentences, more 
or less distinctly. A half year after I again saw the patient, and he 
has steadily improved in speech and developed physically and intellect- 
ually in a marked degree. 

From the foregoing, it is apparent that while deaf mutes may not 
be cured in every case by operative measures, adenoid vegetations 
play an important part in the production of deaf -mutism, and that if 
due attention were paid to this in early infancy, the number of deaf 
mutes could in time be greatly decreased. 

The literature of rhinology is, as usual, abundant, and comes from 
all quarters of the globe, but the most impressive fact in it all is the 
increasingly conser\'ative (spirit manifested in nasal surgery. A strong- 
and wide-spread reaction is now taking place against the too free use 
of heroic surgical procedures for the mere purpose of making the two 
nasal chambers artistically symmetrical. Remarks made by Goeyville 
McDonald, President of the British Rhinological Society, in discussing 
turbinotomy at the last meeting of the Society, is a clear and authori- 
tative statement of this fact. " I have heard the views of those who 
advocate the larger operations on the turbinals for the relief of 
obstruction to respiration or for the removal of certain neuroses, yet 
while amply convinced of the feasibility of such operations and of the 
relief they may afford, while even admitting that no appreciable harm 
may be done, yet I have not, for my part, seen the cases when the 
desired relief could not be procured by milder measures. And we 
have yet to see whether, in the course of a few more years, we shall 
not encounter in these patients definite evidence of chronic inflamma- 
tion of the larynx and morbid condition of the nose resulting from 
the removal of what may justly be described as the most important 
portions of the nose." 

Something more than a year ago, after most exhaustive study of the 
bacteriology of ozaenic crusts and discharges, Drs. *Bellfanto and 
Devoda proposed the injection of diphtheritic antitoxin for the treat- 



APPENDIX TO THE MINUTES. I43 

ment of this hitherto well-nigh incurable disease, and reported cases 
of cure. The treatment was enthusiastically tried for some time, but 
seemed to have been found ineffective. But a revival of the serum 
therapy has recently occurred, and cases of apparent cure are reported 
by Vanderpoel, of New York, Moun, of London, and many others. 
In a very recent paper, Dr. Moline, of the French Laryngological and 
Rhinological Society, reports three cases of advanced ozsenic rhinitis 
having been cured by repeated injections of ten cubic centimetres of 
Roux's diphtheria antitoxin, and, as stated by Dr. Compaired, "at 
present the procedure is one which furnishes the most positive results 
in the treatment of ozsna." He states that the fetor disappeared 
after two or three injections of five or six cubic centimetres of serum. 
The mucous membrane becomes redder and moist, and the crusts 
become less abundant and dry as the treatment continues. He 
cautions against such large doses as ten cubic centimetres, as originally 
proposed, and concludes that while the treatment is inconvenient and 
not without risk, " on the other hand it furnishes such very positive 
results, it is proper that the method should be carefully pursued." 

A year ago, Dr. Delavan proposed a new method of permanent 
relief of certain enlargements of the turbinated bone. His aim was 
to reduce the volume of the congested turbinates without loss of 
mucous membrane. He therefore advocated the method of sub- 
mucous incisions. For this purpose he used a very slender knife 
which is more like a needle than a knife. First applying cocaine in 
the usual method, the blade is passed under the mucosa, making a 
sweep through the sub-mucous tissues and then withdrawn, care 
being taken to avoid any additional enlargement of the original 
opening. The effect of this procedure is, of course, to cut off a 
portion of the blood supply to the congested area. The claims which 
Dr. Delavan made for the operation, viz., ease of execution, freedom 
from bad effects, preservation of mucous membrane and adaptability to 
the desired end, have, I think, been substantiated by a year's experience, 
and the operation has gained a permanent place in nasal surgery. 

Among the newer drugs, eucain is establishing itself as a safe and 
satisfactory anaesthetic is most cases of nose and throat surgery^ The 
interest of the fact lies largely in the positive need of some safe and 
reliable substitute for cocaine, first, because of the disagreeable and 
often dangerous effects of even small quantities of the drug upon the 
nerve centres, but more particularly because of the spread of cocaine 



144 MEDICAL SOCIETY OF NEW JERSEY. 

inebriety, a mischief which, I think, in many cases, may be traced 
primarily to the rhinologist and dentist. Of eucain, a four per cent, 
solution is sufficient for purposes of examination, and a ten per cent, 
for operations. 

A new preparation called nosophen, an antiseptic iodine compound, 
has recently appeared, and it seems in this drug we have at last a 
-worthy substitute for iodoform. It appears to possess all the.latter's 
antiseptic properties, without its disagreeable odor and without toxic 
•effect. It is a yellowish gray inodorous powder, insoluble in water, 
and contains about sixty per cent, of iodine in combination. A prep- 
aration soluble in water and called antinosine is also made, but with 
this I have no experience. 

Dr. Scott Bishop, Professor of Diseases of Nose, Throat and Ear 
in Chicago Medical College, was the first to put the drug to a severe 
test, in a long series of obstinate cases af suppurations that had 
resisted older remedies. As a result, he now enthusiastically com- 
mends nosophen in preference to iodoform, peroxide of hydrogen, 
aristol, boric acid and similar medicaments in suppurative conditions 
of ear and throat. 

I have used it with very gratifying results on mucous patches, tuber- 
cular and syphilitic ulcerations of the larynx and nose, after intra- 
nasal surgery, as dusting powder, or on gauze packing. It being 
distinctly astringent as well as antiseptic, it deserves an extended trial 
in simple chronic rhinitis, attended with profuse muco-purulent 
discharge. 



Paper read by B. Meade Bolton, M.D., Prince- 
ton, N. J., ON •* Progress in Bacteriology." 

Progress in bacteriology during the last year has not been marked 
by any far-reaching discovery that can compare with the discovery of 
•diphtheria antitoxin, or the discovery of any distinctly new principle, 
with the possible exception of the use of bile in inoculations for 
"" rinderpest " and snake poison, to be referred to later. On the other 
hand, a great deal has been done in widening '^the scope of principles 
already discovered and in defining the limits in which these principles 
are applicable. The amount of work that has been done is very 
large. Baumgarten's " Year Book of the Progress of Bacteriology," 



APPENDIX TO THE MINUTES. I45 

giving a brief synopsis of the work for 1897, is an octavo volume of 
nearly 800 pages (793 pages), and this embraces only medical bacteri- 
ology. This volume has only recently appeared and was compiled by 
Baumgarten with the aid of six co-workers. It is evident, therefore, 
that only a very few of the contributions can be referred to in a paper 
of this kind. I have therefore selected those contributions that appear 
to me to be of the most general importance and to be of the greatest 
immediately practical value to physicians. I have consequently given 
blood serum therapy the most consideration as being the subject in 
bacteriology where the greatest results have been accomplished, for in 
this line of investigation the value has been more and more clearly 
demonstrated in some directions, the limits more sharply marked in 
others and finally the uselessness shown in others. 

Diphtheria. — Contributions to the study of diphtheria have been 
made in several directions. Several pieces of work have been done 
with a view to making the diagnosis of the micro-organisms more 
certain, but these have led to no important change in the method of 
making examinations. Experience still shows that, with the use of a 
proper medium, cultures from the throat of a diphtheria patient will 
reveal the characteristic bacilli in nearly every case on the first examin- 
ation, even before there are any severe clinical symptoms. The 
medium found to be best suited is the Loeffler's blood serum, beef tea 
made with horse's blood serum. 

Several articles have appeared on the efficacy of antitoxin in diph- 
theria, and they all tend to add to the evidence in favor of the efficacy 
of this mode of treatment ; indeed, I have failed to find any dissenting 
voices. As experience increases, the value of antitoxin becomes more 
and more apparent. Statistics for Paris ancl Berlin and for all German 
cities of over 15,000 inhabitants, which I give below, show very 
strikingly the decrease in the ravages from diphtheria since the 
general use of antitoxin. 

Charit6 Hospital, Berlin. — From April i, 1888, to March 31, 1894, 
894 cases ; 487 deaths, or 55 per cent., previous to the use of antitoxin. 
From April i, 1894. to March 3r, 1898, 842 cases; 132 deaths, or 16 
per cent., after the introduction of the antitoxin treatment. 

In all the hospitals of Berlin, including the above. — From January i, 
1885. to December 31, 1893, 16,451 cases; 6,198 deaths, or 38 per 
cent., previous to the use of antitoxin. From January i, 1895, ^^ 



10 



146 MEDICAL SOCIETY OF NEW JERSEY. 

December 31, 1897, 7,146 cases; 1,032 deaths, or 14 per cent., after 
the introduction of the antitoxin treatment. 

In all the hospitals and private practice in Berlin.— From January i» 
1885, to December 31, 1893, 36,904 cases; 11,145 deaths, or 3'^ P^^ 
cent., previous to the use of antitoxin. From January i, 1895, to 
December 31, 1897, 14,174 cases; 2,092 deaths, or 14 per cent., after 
the introduction of the antitoxin treatment. 

In all German cities over 1 5,000 inhabitants. — Mortality from diph- 
theria: From 1886 to 1894, both inclusive, 106 per 100,000, previous 
to the use of antitoxin; from 1895 to 1897, both inclusive. 44. per 
100.000, after the introduction of the antitoxin treatment. 

In Paris, death rate per year: From 1886 to 1893 inclusive, 1522, 
before the use of antitoxin ; from 1895 to 1897 inclusive, 376, after the 
introduction of the antitoxin treatment. 

With such an array of statistics as this, comment is hardly neces- 
sary. This seems to be the best that can be accomplished, since the 
death rate fell to about the figures given above as soon as antitoxin 
began to be generally employed — from the middle of 1894 — and since 
that time the figures have remained about the same, It is possible* 
however, that the employment of antitoxin as a prophylactic remedy 
in hospitals, asylums, schools, prisons and in private practice may still 
further reduce mortality. Experiments in this direction have proven 
very promising. If all the patients in the ward in which a case of 
(diphtheria first occurs were given a prophylactic dose, or all the mem- 
bers of a family were similarly treated, it would probably lead to stiU 
better results. 

In the production of antitoxin the advances have consisted mainly 
iin the production of stronger antitoxin in order to reduce the amount 
of the dose administered. The advantage of giving smaller doses of 
concentrated antitoxin seems now to be the more desirable method of 
administration. The concentrated antitoxin may be produced by 
evaporation or by using serum, naturally very' potent. 

Tuberculosis. — In the method of diagnosing tuberculosis, I can- 
not find that any modification in method already employed have been 
recommended. 

Articles have appeared tending to modify the view that dried bacilli 
floating in the dust is the most usual mode of infection. It is con- 
tended that small particles of sputum coughed up and sputtered 
about are a more fruitful source ; that consequently the danger from 



APPENDIX TO THE MINUTES. I47 

sputum consists not, as has been supposed, (torn its becoming dried 
and taken up in the air, but from particles coughed out into the air. 
Experiments have]been made to show that it is rarely possible to 
produce tuberculosis of the lungs by making animals inhale dust 
impregnated with dried tubercle bacilli, but if moist cultures are 
sprayed into the air the animals always become infected. If this is 
true it would seem that it is important not only to prevent phthisical 
persons from expectorating about the floor or ground, but also to 
take measures to prevent them from spreading particles of sputum 
in the air during a paroxism of coughing. It has been shown that 
bacteria can be thrown a distance of ten metres and more by violent 
coughing. Attention has also been recently called again and empha- 
sized to predisposing causes, climatic influences, any excessive drain, 
worry, imprisonment, need, misery, hunger— briefly, depleting circum- 
stances of any kind; furthermore, inherited predisposition and the 
virulence of the bacilli in the special case. 

The spread of tuberculosis in butter has received considerable 
attention. Some claimed to have found tubercle bacilli constantly, 
others in thirty per cent, and more. Rabinowitsch, however, has 
shown that an organism nearly resembling the tubercle bacillus of 
man in its tinctural peculiarities, but not identical with the latter, is 
very frequently present in butter, and casts very grave doubts upon all 
the results of other investigators in this direction. Moreover, Theo- 
bold Smith has recently shown that the bovine tubercle bacillus is not 
identical with the tubercle bacillus of man, as has been usually 
assumed. So our ideas of the spread of tuberculosis from dairy 
products must undergo modification. Out of eighty samples of 
butter, Rabinowitsch was unable to fini genuine tubercle bacilli a 
single time. In twenty-three samples there was a bacillus which 
•caused the death of guinea-pigs, but this bacillus was not identical 
with the tubercle bacillus. Schuchart obtained similar results. 

In regard to the bacteriological therapeutics of tuberculosis, the 
matter stands very differently than with diphtheria. Results in this 
direction are little short of discouraging. Efforts have been made in 
two directions. On the one hand, attempts at the production of an 
anti-tubercle serum ; on the other, of a substance derived from the 
bodies of the bacilli, /'. e., the so-called new tuberculin T. R. In 
regard to the anti-tubercle serum, little need be said. It is prepared 
in a manner analagous to that employed in the production of diph- 



148 MEDICAL SOCIETY OF NEW JERSEY. 

theria antitoxin. I have the verbal statement of two investigators 
who have attempted it, that it is impossible to obtain anti-tubercle 
serum from horses, since these animals die from the inoculations 
invariably, even of very small doses of cultures of tubercle bacilli. 
It is possible, however, to use other animals. The clinical results 
obtained by the use of serum of this kind are not encouraging. I 
have recently tested two specimens from different producers on 
guinea-pigs, and so far from curing or even preventing tuberculosis in 
guinea-pigs, the animals that received the serum emaciated more 
quickly and died sooner of tuberculosis than animals inoculated with 
the tuberculous sputum and cultures alone. 

Clinical evidence in regard to the new tuberculin, the T. R., though 
somewhat conflicting, is, on the whole, rather unfavorable. Most of 
the best clinicians who have tested it are holding their final decision 
in abeyance. A few clinicians have given it unqualified endorsement, 
others have condemned it and even warned the profession against its 
use. In some cases very disagreeable and even' alarming symptoms 
have followed ils use. Certainly no definite conclusion has been 
arrived at yet. 

It may not be unprofitable to say something in regard to this new 
preparation of Koch, not only on account of its barely possibly value 
in treating tuberculosis, but mainly because Koch states very clearly 
his views in regard to immunity from infectious diseases produced by 
the use of substances derived from bacterial cultures, and points out 
the direction of efforts of bacteriologists at combatting these diseases. 
Koch points out that, to use his own words, "Originally it was 
thought that immunity from infectious diseases was something simple, 
undivisible. Gradually, howfever, the opinion has gained ground more 
and more that immunity may be a simple matter, but is not necessarily 
so ; that it may consist of two or perhaps more components." He 
then cites examples. 

In tetanus, immunity can be produced by gradually increasing 
amounts of the liquid portions of a tetanus bacillus culture. This 
renders the animal insusceptible to the poison of the cultures, but the 
bacilli grows in the tissues of the immunized animals without pro- 
ducing any disease. On the other hand, in cholera and typhoid it has 
been shown that by the use of solid cultures, /'. <?., of the bodies of 
the bacteria of these diseases, animals may be made to resist the 
growth of the bacteria in their tissues, but are not resistant against 



APPENDIX TO THE MINUTES. 149 

the poisonous products of these bacteria. " The ideal production of 
immunity will always be to protect the body, not alone from a single 
injurious property which the pathogenic bacteria bring with them, but 
from all these. These considerations play an important r6le in 
tuberculosis." 

At first glance it would seem that there could be no immunity pro- 
duced in tuberculosis. Man and animals suffer for years without 
exhibiting any greater resistance to the diseases than when freshly 
affected ; on the contrary, seem more and more unable to resist the 
disease. But there is a period in acute milliary tuberculosis of man 
and of guinea-pigs when there is a flooding of the tissues with the 
bacilli, followed by a disappearance of the bacilli, a time when the 
bacilli seem to have in* some way produced a condition of the body 
where the latter is no longer suited for their growth. Unfortunately, 
this condition comes too late to be of any use to the individual in 
nature. But can it be brought about artificially .^ Can the body in 
any way be suddenly flooded with tubercle bacilli at a period of the 
disease when the body is able to resist ? This is the object aimed at 
by Koch. The difficulty is in getting the bacilli disseminated in the 
body. If they are injected under the skin they remain local and 
produce an abscess, spreading only in the form of foci by metasticis 
to near or remote organs. Various methods were tried to make the 
bacilli absorbable, but the only one that proved finally satisfactory is 
that' employed in the production of the so-called T. R. This consists 
in rubbing up masses of dried bacilli in an agate mortar with an 
agate pestle till microscopic preparations show few or no bacilli that 
can be stained ; the mass is then mixed with distilled water and cen- 
trifuglized. This separates it into an upper layer, T. Obere Schicht. 
and a lower layer, T. Rest. The T. R. is several times washed and 
centrifuglized. The T. O. resembles somewhat in its action the ori- 
ginal tuberculin. 

Typhoid Fever. — In typhoid fever I cannot find that any important 
advances have been made, aside from the general use of the Widal's 
test, for diagnostic purposes. In regard to the value of Widal's test 
opinions are, on the whole, favorable. It is certain, however, that 
thoroughly trustworthy results can be obtained only with great care« 
The Widal's test depends upon the fact that the blood of persons 
suffering from typhoid fever, after the first few days, has the power of 
agglestinating and finally disintegrating the bacilli of the disease. The 



ISO MEDICAL SOCIETY OF NEW JERSEY. 

reaction can be seen with the naked eye as well as with the micro- 
scope. If a small amount of the blood to be tested is put in a bouillon 
culture of typhoid fever bacilli, the latter clump together and become 
motionless and finally break up into granules. It is really a special 
application of the so-called Pfeiffer's phenomenon observed in cholera 
and other bacterial diseases. A few reports of cases of typhoid fever 
treated with serum are to be found, but on the whole no very favor- 
able results have been observed. 

Strepjococcus. — The experience in the last > ear with anti-strepto- 
coccus serum has not been encouraging. Some of the best observers 
have failed to see any benefit in cases of puerpural fever and other 
streptococcus infections, either in human beings or experimentally in 
animals. It is probable that this method of treatment will be less and 
less employed. 

Rinderpest. — Very interesting and important are the results of 
Koch's investigations of rinderpest in Africa. These are worthy of 
more than passing notice because of the new possibility they offer in 
other diseases, perhaps in some diseases affecting man. Koch found 
that by inoculating healthy cattle with lo c. c. of bile obtained from an 
animal dead of the rinderpest, immunity lasting forty to sixty days was 
produced. Dr. Krause, of the Orange Free State, advises a subse- 
quent inoculation with lo c. c. or more of blood from an animal 
suffering from the disease. The finding of an immunity substance in 
the bile of an affected animal is a new observation and, as already 
stated, may be of value in other diseases. Similar observations have 
also been made in cases of snake poisoning. 

Tetanus. — The serum therapeutics of tetanus is rather gaining 
favor. There have been several cases reported where the antitoxir^ 
was beneficial. It is of value only in the initial stages and differs from 
the diphtheria antitoxin in acting gradually ; there is no sudden or 
striking improvement in a short time. In veterinary medicine there is 
a good deal of evidence in favor of the antitoxin, although there is also 
not lacking a number of cases in which the antitoxin did not seem ta 
be of any benefit. Dickerhoff's statistics are the most favorable of all, 
apparently. He had 1 1 5 cases of tetanus in horses in the time from 
^890 to 1896, with only twelve recoveries, or about ten per cent, cured ; 
after the use of antitoxin, from 1896 on, he had fifteen recoveries in 
28 cases, or fifty-three per cent, cured ; or really fifteen recoveries in 
twenty-three cases, or sixty- five per cent, cured, for in five cases the 



APPENDIX TO THE MINUTES. 15I 

horses were bought in a moribund condition. On the other hand, 
Nocard regards the treatment unfavorably although he cured thirty- 
three horses out of seveiity-four cases, or forty-five per cent of cures. 
Nocard highly recommends the use of antitoxin where there is a 
likelihood of tetanus developing, as in cases of deep, dirty, punctured 
wounds as a prophylaxis. In one locality in Paris it has become the 
practice of veterinarians to administer antitoxin in all cases of injury 
in horses that would be likely to develop tetanus, and where this was 
tried, tetanus has disappeared entirely from the locality. 

Bubonic Pest. — In bubonic pest the serum has proved itself of 
great value. Yersin used the treatment and cured 93.5 per cent, of 
cases, whereas the mortality usually in this disease is 80 to 90 per 
cent, and more. 

Syphilis. — One of the most important contributions recently made 
is the study of syphilis by Van N lessen. Van N lessen claims to have 
found the micro-organism and describes it very fully. It is classed as 
a pleomorphic bacillus nearly allied to the higher filiform fungi. It can 
be found in every case and in every stage of the disease after the blood 
becomes infected. It can be detected by staining preparation of the 
blood as well as by cultures ; in many cases also in the urine. He 
finds be can infect rabbits, and that in rabbits as in man, the disease 
is capable of being inherited and of being contracted in every stage ; 
that the disease is incurable by any method known ; that so-called 
cures are merely latent stages of the disease. The work that Van 
Niessen has done is worthy of the greatest respect, and all of his 
conclusions are based upon the most careful clinical observation and 
experimental tests. His conclusions will probably not be accepted 
generally without corroboration In the meantime it must stand as 
a recent and most valuable contribution to the study of this important 
disease. Serum therapeutics has also been tried in syphilis. The serum 
was obtained by injecting syphilitic condylomata into horses and then 
using the blood serum of these ; but the serum proved to be of no 
value, in fact, patients were injuriously afifected. 

Leprosy. — In the Lepra conference in Berlin last October, opinions 
were much divided as regards the efficacy of the serum treatment 
in leprosy. Several very high authorities regarded it with favor. 

To sum up briefly. Progress has consisted in demonstrating still 
further the value of diphtheria antitoxin ; the production of an anti- 
toxin for bubonic plague that has shown itself of great value ; the 



152 MEDICAL SOCIETY OF NEW JERSEY. 

favorable results obtained in cases of tetanus with the tetanus anti- 
toxin, especially in veterinary practice ; the demonstration af antitoxin 
in the bile of cattle suffering from rinderpest, and of antitoxin in the 
bile of poisonous serpents ; the demonstration of the probable useless- 
ness of streptococcus sentm, and also of syphilis antitoxin. 



External CEsophagotomy ; Report of an Opera- 
TiON FOR Impacted Foreign Body in the 

CESOPHAGUS LOCATED BY THE X-RaY. 
BY JOHN C. MCCOY, M.D., PATERSON, N. J. 

Since Goursald, in 1783, first removed by external incision an 
impacted body from the oesophagus, the operation has been performed 
upwards of 175 times, most of the cases having been operated upon 
during the last fifteen years. Bones, artificial teeth and coins consti- 
tute the majority of impacted bodies calling for operative interference. 
In the entire number of cases operated upon up to the present time 
the mortality has been twenty-two per cent. This includes those 
cases in which the impaction has been of long standing, as in Dr. 
Furner's case, in which he removed, by an incision in the posterior 
wall of the oesophagus, a dental plate which had been lodged there 
for nearly five years, and those cases in which the impaction has been 
of but a few hours duration. The mortality during the period of 
aseptic surgery has been lowest in those cases which have come to an 
early operation, in which patients the tissues have not been contused 
and lacerated by frequent and prolonged efforts to dislodge the body 
by means of the various oesophageal instruments, and has been 
highest in those cases where some time has been allowed to elapse 
between the impaction of the foreign body and its removal. 

In looking over the literature of the subject, I am inclined to believe 
that in many of the cases better results might possibly have been 
obtained had the operation been resorted to at an early hour after the 
impaction had become complete, rather than wait for a considerable 
length of time and then operate when the tissues are partially devital- 
ized and the field of operation perhaps infected. When we are sure 
that the impaction has become complete, the rule should be to operate 
at once. Nothing is to be gained by procrastinating, as under proper 
conditions the operation is not difficult and the results are most 
gratifying. 



1, SHOWING LOCATION OF FOBEIOB . 



APPENDIX TO THE MINUTES' 1 55 

The case which it is my privilege to report occurred in the practice 
■of Dr. W. K. Newton, of Paterson, N. J. The history is as follows : 
On May i, 1897, C. D., male, age 7, while playing was suddenly seized 
with severe retching and coughing. His mother, upon questioning 
the boy, learned that he had swallowed a small tin whistle with which 
he had been playing. Dr. Newton saw the child two hours after the 
accident occurred, at which time the child was suffering from rather 
marked dyspnoea and absolute inability to swallow even water. At 
«ight p. m.. four hours after the accident, the dyspncea had become 
more marked ; there wa^ slight cyanosis, the respiration being 
labored and rapid ; cedema was present under the eyes and there was 
complete inability to swallow; the tongue was somewhat swollen and 
the pharynx markedly congested ; palpation elicited a slight bulging 
in the median line about an inch above the sternal notch. 

Appreciating the shape of the foreign body, the patient was placed 
under complete chloroform narcosis and a long coin-catcher passed 
down the oesophagus. The impact of the instrument against the 
metalic body could be readily felt, and after some little effort it 
gripped the body firmly, but slipped off when traction was made upon 
it. and no further hold of the body could be obtained. After this 
manipulation the prominence which had been felt just above the 
sternum could no longer be distinguished. The breathing at this 
time became much less labored, and in a short time the child was able 
to swallow liquids, although with considerable difficulty. 

Thinking that the whistle, which had been lodged at right angles to 
the oesophagus, was now located parallel to it, it having been tilted 
into this position by the coin-catcher — which fact would have 
accounted for the disappearance of the dyspnoea owing to pressure 
being taken off the trachea, and his ability to swallow, to the fact 
that the lumen of the oesophagus was not now entirely occluded — a 
basket-shaped catcher was made of medium sized copper wire and an 
endeavor was made to pass this beyond the foreign body, hoping to 
engage the body as the instrument was withdrawn. All efforts to 
reach the body were unsuccessful and, owing to the congested and 
swollen condition of the pharynx, further manipulation was dis- 
continued . 

The following morning, the breathing being somewhat impaired and 
dysphagia rather marked— although the child was able with some little 
-effort to swallow milk and egg— there was a feeling of uncertainty as 



156 MEDICAL SOCIETY OF NEW JERSEY. 

to whether the foreign body might not have been pushed on into the- 
stomach and the dysphagia was not the result of our efforts of the 
preceding night to dislodge it. That afternoon the X-ray exposure 
was made extending from the chin to the umbilicus, and it showed 
distinctly the whistle lodged transversely in the median line of the 
neck about an inch above the sternal notch. The boy was transferred 
to the private ward of the hospital and at ten o'clock the following 
day, being forty-one hours afler the impaction of the body, was 
operated upon. 

OPERATION. 

An incision from the lower border of the cricoid-cartilage 10 the 
upper margin of the sternum, extending along the anterior border of 
the left serno-mastoid muscle. The muscle was drawn to one side, 
the sternal attachment of the sterno-mastoid divided so as to afford 
more room, and the dissection then carried down to the large vessels 
which in their sheath were drawn outward by a short retractor. The 
trachea and thyroid gland were drawn inward by a second retractor. 
The oesophagus, with the recurrent laryngeal nerve lying upon it, was 
next exposed. When reached, the oesophagus, with the adjacent 
tissues both above and below the foreign body, were considerably 
swollen and congested, and at the side where the whistle was in 
contact with the oesophageal wall the wall was decidedly thinned, 
showing the utter futility and great danger which would have resulted 
from an endeavor either to draw the body up or force it down. In 
either case the oesophagus could have hardly escaped being ruptured 
and the tissues greatly contused and lacerated. 

An incision an inch long was next made on the anterior surface of 
the oesophagus, a trifle to the left of the 
median line and directly over the foreign 
body, A fine silk ligature was then passed 
through the edges of the oesophageal wall in 
order that the wound might be held open. 
When a tenaculum was introduced into the 
small opening of the whistle, the whistle 

rotated until it assumed an antero-posterior 1 

direction, when it was readily withdrawn. "^ ^" Whistle, Actual size. 

The tissues were then thoroughly cleansed with boracic acid solu- 
tion, the wound in the oesophageal wall closed with interrupted 
sutures of fine catgut placed closely together, and the superficial 




APPENDIX TO THE MINUTES. 1 57 

wound closed with interrupted sutures of silk. Small pads of iodo- 
form gauze were placed over the wound and a bandage applied snugly 
about the neck, so as exert considerable pressure over the wound 
in order that counter-pressure might be exerted during the act of 
swallowing. There was only slight shock and absolutely no nausea 
or vomiting following the operation. Small portions of sterilized 
water were administered as soon as the patient was able to swallow 
and continued at intervals of every half hour to an hour. At the end 
of twenty-four hours sterilized milk was administered, and after each 
feeding a few sips of sterilized water were given in order that the 
oesophagus might be thoroughly cleansed after taking the milk. A 
small opening appeared in the lower angle of the wound on the third 
day, and when the patient swallowed, a portion of the fluid found its 
way through this opening. Firm pressure upon the wound when the 
patient was taking nourishment remedied this entirely. The fistulous 
tract closed in seven days, and on the sixteenth day the patient left 
the hospital. He was able to take solid food and was apparently in 
good health. At no time after the operation did he have a tempera-* 
ture above 99° F. 

In the light of this case I would draw the following conclusions : 
First. A foreign body impacted in the oesophagus for over twelve 
hours, particularly if it be known to have edges liable to inflict injury 
upon the tissues if traction be made upon it, should be removed at 
once by external incision. 

Second. The prolonged and continued use of the various oeso- 
phageal instruments should be condemned, as the tissues are usually 
contused and lacerated by their use and their vitality and resisting 
powers lowered. 

Third. Where the tissues have not been lacerated and the impac- 
tion has not been of long duration, the tissues appearing healthy, the 
oesophagus should be closed with fine catgut and the external wound 
closed completely. 

Fourth. It is better to give small portions of sterilized water at an 
early hour after the operation, in order that the oesophagus may be 
kept as clean as possible. Feeding by tube or restal feeding is usually 
uncalled for. At the end of twenty-four hours liquid nourishment 
may be given, and after each feeding a few sips of sterilized water 
administered so that the oesophagus may be again cleansed. 



158 medical society of new jersey. 

Report of Thirteen Cases of Appendicitis, with 
Presentation of Eight Morbid Specimens. 

BY JOHN C. MCCOY. M.D., PATERSON. N. J. 

While there is no branch of abdominal surgery which has been kept 
more constantly before the profession of this country during the past 
ten years than that of the affections of the vermiform appendix, there 
is today, even with the accumulated knowledge of the past, no more 
•difficult problem for the surgeon to solve than when, in certain cases 
of acute appendiceal trouble, surgical interference should be instituted. 
This question is particularly difficult of solution, since we will occa- 
sionally see cases in which the symptoms are most marked and severe 
from the very outset, and yet these same cases will at times get well 
without operation, while cases presenting symptoms of a less severe 
character will progress rapidly from bad to worse and show, at the 
time of operation, the disease in its most intense form. 

During the past year I have seen thirteen cases of appendicitis. 
Two of these were cases of chronic relapsing appendicitis which 
recovered without operation. One was an acute attack which 
recovered after a prolonged illness ; in this case there was a second 
attack three months later. In the remaining ten cases which were 
operated upon the patients gave no history of previous attacks. 
While none of the cases show items of unusual interest, yet four of 
them presented appearances at the time of operation which might call 
for a passing notice. Two of these showed an extremely short meso- 
appendix, in one instance being so short as to cause the appendix to 
describe almost a semi-circle. In this condition it would seem that 
any fecal matter which might find its way into the cavity of the appen- 
dix would, owing to its position, be unable to find easy egress into 
the bowel again. Remaining thus as a foreign body, the tendency 
would be for it to act as an irritant to the mucous membrane and 
thus be an exciling cause in bringing about an inflammatory trouble, 
at the same time acting as an obstacle to the free drainage of the 
distal end of the cavity. 

The third case is one which followed an attack of typhoid fever of 
a protracted and severe nature, occurring eight months previous. 
During the interval between the attack of typhoid fever and the acute 
appendiceal trouble, the patient had several attacks of severe abdo- 
minal pain lasting from three to ten days. I saw him in each of these 



APPENDIX TO THE MINUTES. 1 59 

attacks, but at no time were the symptoms of such a nature as to war- 
rant, to my mind, a diagnosis of appendiceal trouble being made, and 
yet at the time of operation there was every evidence of trouble of long 
standing. In another case the appendix was intimately adherent to a 
pus tube. The tubal trouble was of long standing and the infection 
had undoubtedly been transferred from the tube to the appendix. 
There was a constricture in the lumen of the appendix about an inch 
from its distal end, and the distal pouch formed by this constricture 
contained about a drachm of pus. 

In eight of the cases operated upon the appendix was removed ; in 
the remaining two the conditions were such that the abscess cavity 
was simply washed out and drained. The ages of the patients ranged 
from seven to twenty-six years, there being but one patient over 
sixteen years of age. It is of interest to note that of the thirteen 
cases, twelve were males. Of the thirteen cases, three died. In 
these three cases the operation was performed from three to ten days 
after the onset of the acute symptoms, and in each of the cases there 
was more or" less pus in the free peritoneal cavity. In two of the 
cases the condition of the patients was extremely bad when they 
came on the table.. 

Following is a brief summary of the symptoms presented by the 
thirteen cases, and the histories of the eight cases from which the 
appendices were removed : 

Pain was present in all the cases save one. In six of the cases it 
was confined largely to the right side. In one case it was referred to 
the epigrastric region. In four there was general abdominal pain. 

Nausea and vomiting present in nine of the cases. In eleven, were 
coincident with the onset of the acute symptoms ; in the remaining 
two, appeared later. 

Tympanites was present in ten of the cases ; in two of the ten 
cases was very marked. A considerable amount of pus was in the 
abdominal cavity and a great deal of plastic lymph upon the intestines. 

Temperature varied from 99J to io4f, the most severe case having 
the lowest temperature. In this case, while the temperature was 99J, 
the pulse was 130 and extremely weak; the case with the higher 
temperature having a pulse of 1 10 and good quality. 

Condition of the bowels. In nine of the cases there was a history 
of a period of constipation preceding the attack. In four of the cases 
the acute symptoms were preceded by a diarrhceal condition. In only 
four of the cases could a tumor be distinctly felt. 



i6o MEDICAL SOCIETY OF NEW JERSEY. 

Case i. L., male, age lo. Perfectly well up lo the morning of 
September 9th, 1897 : was seized with severe* abdominal pain which 
was immediately followed by nausea and vomiting, lasting for iwenty- 
four hours, and subsiding on third day. During the next twenty-four 
hours had eleven fluid discharges front the bowels. At this time ) 
gr, of opium was given by the attending physician, every hour until 
the pain subsided. Saw him first on the morning of the Rfth day. 



Temperature 104I ; pulse 1 ro ; respirations 42. Facial expression bad. 
Yellowish hue to the conjunctiva, and skin dry : sordes on teeth and 
tongue thickly coaled. Abdomen greatly distended; superficial 
vessels dilated ; resonance over the entire abdomen tympanitic. Legs 
and thighs Hexed ; absolutely no tenderness, even on deep palpation. 
Marked rigidity of muscles on right side of abdomen. 

O/ifru ton September 13th. Incision in left iliac region; marked infil- 
tration of the wbdoniinal muscles. Upon opening the abdomen there 



APPENDIX TO THE MINUTES. l6l 

"Was a large amount of extremely feiid gas expelled, and following this 
the withdrawal of about twenty ounces of greenish pus. Examination 
showed that there was a complete walling of the abscess cavity. A 
-coil of small intestine was intimately adherent to the ccecum by a 
thick layer of plastic lymph. Tip of appendix was adherent to small 
intestine and a mass of gangrenous -loo king omentum adherent to the 
appendix throughout its entire length. Omentum ligated well above 
the sloughing portion; appendix freed from adhesions; serous coat 
stripped down near coecum : stump ligated and cauterized with car- 
bolic acid ; serous coat stitched over slump and cavity flushed wiih 
saline solution ; wound left open and packed with iodoform gauze. 
Packing removed in twenty-four hours. Temperature six hours after 
operation, 99}. Abdominal wound was completely closed in five 

Appendix. Small perforation close to the coecum ; walls much 
thickened and covered with a thick layer of plaslic lymph. Fecal 
concretion, size of almond. An extremely short meso-appendix, 
-causing the appendix to describe almost a semi-circle. 



Case 2, C. B., male, age 13. Case seen with Dr. Deyo< 
■Ramseys, N. J., June 13,1897. Was seized with sudden and ini 
■pain in the abdomen seven days previous. During this time 
more or less nausea, vomiting and diarrhoea, with tenderness ove 
■ entire abdomen on palpation. Temperature during the entire s 



l62 



MEDICAL SOCIETY OF NEW JERSEY. 



days ha.d ranged from 99 10 103. Pulse, 100 to 140. During ihree- 
days the abomen had been geatly distended; had had small doses of 
calomel internally and hot poultices applied to the abdomen. 

Examination. Yellowish hue 10 the skin of face, mure marked in 
the conjunctiva; tongue thickly coated; breath fetid. Abdomen 
greatly distended ; superficial veins prominent ; marked tenderness 
over the entire abdomen, most marked in the right iliac fossa ; reson- 
ance here dull; elsewhere over the abdomen, tympanitic; abdominal 
muscles, particularly on the right side, extremely rigid. Temperature, 
104; pulse 130; respirations 48. The patient's condition seemed so 
desperate that it was deemed unwise to move him, and he was, there- 
fore, rapidly prepared for operation. 

Operation. Peritoneum adherent. Evacuation of about a pint of 
Slinking pus. There was no walling off of the abscess cavity; the 
pus was distributed through the lower portion of the abdomen. 
Omentum adherent to coecum. This was tied off and showed ctECum 



cnrlr than mtv 






coated with a thick layer of plastic lymph. Appendix throughout its 
entire length was adherent 10 the ccecum, and when freed, discharged 
pus from its distal end ; where appendix had been stripped off from 
the caecum there appeared a raw surface along the coecal wall. 
Appendix removed ; coils of intestine separated where held together 
by lymph ; abdomen Hushed with normal salt solution ; wound left 
open and packed with iodoform gauze. Recovery was complete in 

Appendix. About the length and thickness of an adult thumb ; 
greatly distended in its central portion; cavity contained a fecal con- 
cretion ; perforation at distal end ; short meso-appendix. 



APPENDIX TO THE MINUTES. 163 

Case 3. J. M., age j6, painter. While working on November 10, 
1S97, was seized suddenly wiih excruciaiing abdominal pain; was 
seen by his physician shortly after this, and was given i grain of 
morphine hypodermically ; during the succeeding twenly-four hours 
the morphine was repealed several times. I saw him for the first 
time November 13 ; temperature 99: pulse 130: respiration 38. Ha^ 
had no nausea or vomiting ; bowels had not moved for several days, 
although prior to the onset of (he acute symptoms he had felt well 
and could not recall ever having had a severe attack of abdominal 
pain before. Facial expression bad and pulse extremely weak ; tongue 
thickly coaled and brtaih very offensive. 



Operation, forty-eight hours afler the onset of the acute symptoms. 
Parietal peritoneum adheront ; aboul a quart of pus evacuated from 
the free abdominal cavity ; large mass of omentum adherent (o the 
Cfficum. The ccecum, appendix and a coll of small intestine were 
bound together In one mass; the Intestine and omentum in this 
position were congested and swollen and looked almost gangrenous ; 
the peritoneum was considerably thickened ; there was no walling off 
of the abscess cavity. Omentum tied off; small intestine (reed from 
coscum : appendix removed, and abdomen flushed with saline solution ; 
wound left open and packed with Iodoform gauze. Patient failed to 
regain consciousness, and died a few hours after the operation. 

Appendix extremely short, ils walls greatly thickened; ihe cavity 
contained a small fecal concretion. There was a small perforation at 
the caeca) end of the appendix. 

Case 4. A. S., Male, age 1;. Was seized with severe abdominal 



164 MEDICAL SOCIETY OF NEW JERSEY. 

pain, which was followed in a short time by nausea and vomiting and 
several watery discharges from the bowels. At the end of forty- 
eight hours from the onset of the acute symptoms, at which time I 
first saw him, the nausea and vonriiting still persisted. Examination 
showed slight tympanites, marked tenderness on the right side upon 
deep palpation, and some swelling. There was also a boggy feeling 
upon palpation in the right iliac fossa. Temperature, 103: pulse, 136. 
Operation, September 20. 1897. Partial peritoneum adherent; 
about two ounces fetid pus swabbed out of the iliac fossa. The 
abscess cavity was walled off from the peritoneal cavity ; appendix 
adherent at its distal end to the ccecum, and when freed left a small 
bleeding area on the ccecum. Appendix removed and a gauze drain 
introduced; the ends of the wound closed with silkworm-gut, the 
surface on either side of the gauze drain being left untied ; packing 



Cah J. — A. Abicebcaviiy; J. diALa]«nd; c- wnllof appondikCDniiderabLy thiDned. 

removed in twenty-four hours ; a smaller drain introduced, and the 
sutures which had been left untied now tied. The patient made 
an uneventful recovery. 

Appendix. There was a small accumulation of pus at its distal 
end, and a constricture of the lumen of the appendix half an Inch 
from its distal end walling off another, and a larger abscess cavity in 
its central portion in which was a fecal concretion, the perforation 
being in the wall of this larger cavity. 

Case j. Male, age 10, B. H. On the morning of May 15, 1898. 
had rather a severe pain in the abdomen ; had been somewhat indis- 



APPENDIX TO THK MINUTES. 165 

posed ior several days previous. I saw him for the first time on the 
afternoon of May 1 5. There was then marked rigidity of the abdominal 
muscles on the right side ; legs were flexed and palpation elicited 
pain over the entire abdomen ; temperature loif, pulse 1 jo; bowels 
had not moved for five days. Hot fomentations were applied to the 
abdomen and i grain doses of calomel administered every hour. A 
high enema, consisting of two ounces of magnesium sulphate, three 
ounces of glycerine and sixteen ounces of hot water, was given the 
following morning, after which the bowels moved freely and his 
symptoms were somewhat relieved. That afternoon, however, his 



vomiting became more persistent, the pain in the right side more 
severe, and his temperature rose to 104 and pulse lo izo. Under 
these conditions operation was advised. 

Operation showed an appendix about as large as adult little finger; 
constricted at its coecal end, bulging in the center and very tense. 
Appendix removed by dissecting serous coat and ligating. Abdominal 
wall was closed completely and the patient made a good recovery. 

Appetidix contained about two drachms of pus and a small fecal 
concretion near its distal end. The wall was considerably thinned. 

Case 6. F. B.. male, age 1 3. Typhoid fever eight months previous. 



l66 MEDICAL SOCIETY OF NEW JERSEY. 

lasting for seven weeks. Since the attack of typhoid fever, has 
had three attacks of severe abdominal pain lasting from three to ten 
days. During each of these attacks the pain was distributed over the 
entire abdomen and at no time did palpation elicit a point of localized 
tenderness. There was no nausea or vomiting during these attacks. 
On the evening of May I2th, the boy attended the gymasium, exer- 
cising rather violently, and took a cold plunge bath immediately after 
his exercise. That night had slight pain in his abdomen and vomited 
once. The following morning the pain was more severe and the 
vomiting more persistent. The vomiting came on suddenly and each 
time he threw off a large amount of greenish fluid ; these vomiting 
spells were followed by a severe chill lasting for several minutes. 

Three p. m. first visit. Patient presented the appearance of one in 
collapse ; eyes sunken and unnaturally bright ; profuse perspiration 
about head ; extremities cold ; right thigh was flexed to its utmost^ 
the patient holding his right knee with his hands ; no tympanites. 
There was a marked tenderness on pressure over the lower 
abdomen, most marked at a point on a line drawn from the anterior 
superior spine of the ileum to the umbilicus two inches above the 
spinous process. Here was felt a hardened mass about the size of 
the index finger, extending nearly to Poupart's ligament ; over the 
mass there was a slight dullness on percussion. Temperature loif;. 
pulse 1 20. At eight p. m. all symptoms were exaggerated. Temper- 
ature 103; pulse 136. Dr. J. L. Leal then kindly saw the case in 
consultation with me, and an immediate operation was deemed 
advisable. 

Operation, Peritoneum adherent ; several ounces of fetid pus 
evacuated ; the appendix pointed down toward the anterior superior 
spine of the ilium and was intimately adherent to the parietal peri- 
toneum, thus accounting for the readiness with which it palpated 
through the abdominal wall. There was no walling off of the abscess 
cavity. A considerable portion of omentum was ligated and left 
attached to the appendix ; the adhesions between the omentum and 
the parietal peritoneum broken up ; cuff of serous membrane stripped 
off coecal end of appendix; appendix ligated and serous coating 
stitched over stump. The abdominal cavity was now thoroughly 
flushed with saline solution ; the wound left open and packed with 
iodoform gauze. On the fifth day, the wound being perfectly clean^ 
chloroform was administered and the wound closed with silk-worm 
gut sutures. Recovery was complete in four weeks. 



APPENDIX TO THE MINUTES. 167 

Appendix. Greatly distended at its distal end ; the distal half was 
completely enclosed in omenium. Section showed a small fecal concre- 
tion which could be easily squeezed out of coecal end. There was a 
perioration near the distal end through which pus had been discharged 
into a cavity in the mass of adherent omentum, which cavity was lined 
with a pyogenic membrane. In the wall of this cavity, in the omentum, 
was a small opening, through which Ihe pus had been discharged into 
the peritoneal cavity. 

Considering, in this case, the history of typhoid fever, the 
recurring attacks of abdominal pain and the pathological changes 
noticed at the time of operation, it would seem fair to presume 
that the exciting cause of the appendical trouble was the attack 
of typhoid fever occurring eight months previous. 



Caic 7. — a. Sita wben dual eud of ippendix «u Adhercnl ; b. tmall abic«t uvity At dUal 

Case 7. This specimen simply shows an appendiceal trouble 
which was secondary to a pus tube. The tubal trouble was of long 
standing. During a month previous to the operation the patient had 
complained of a great deal of pain in her right side, far more than she 
had been accustomed 10 have. It was probable during this time that 
the infection had been transferred from the tube to the appendix. At 
the time o( the operation the distal end of the appendix was adherent 
10 the tube, and when removed, the appendix was found to contain 
about a drachm of pus. The lumen of the cavity of the appendix, at 
its ccecal end. was entirely obliterated. 



I68 MEDICAL SOCIETY OF NEW JERSEY. 

C^SE 8. Male, age i ;. Case seen in consultation with Dr. Deyoe, 
of Ramseys, N. J., June lo, 1898. Boy was seized with sudden and 
severe pain in the abdomen three days previous, accompanied with 
nausea and vomiting. The ilocior saw the case forty-eight hours 
after the onset of Ihe acute symptonris, and diagnosed ii as appendiceal 
trouble. There was at this time some tympanites and tenderness over 
the entire abdomen; temperature 101, pulse 110. The patient was 
having small frequent watery discharges (rom the bowels. Preceding 
this attack there had been a period during which the bowels had been 




CASRB.-a. Fecilcoiiciciian: I. gnpcueil; c, >nd<^. perfotaliou. 

Examination. Slight jaundice of the (ace and a marked yellowish 
hue to the conjunctiva; lympaniies pronounced; tenderness over the 
entire abdomen palpation, most marked over McBurney's point. 
Superficial vessels of the abdomen prominent. 

Operation, Seventy-two hours after the onset o( the acute symp- 
toms. Parietal peritoneum thickened and adherent, and when opened 
there was expelled about four ounces of stinking pus. There 
was no walling of the abscess cavity ; small intestine adherent 10 
ccecum and covered with a thick layer of plastic lymph ; a large piece 
of omentum was also covered with exudate and appeared almost 
gangrenous. Pus was oozing from the small openings near the tip of 
the appendix. Appendix was adherent to the floor of the pelvis and to 
the rectum. Appendix removed ; wound left open and packed with 



APPENDIX TO THE MINUTES. 169 

iodoform gauze. Temperature rose steadily after the operation ; tym- 
panites became more pronounced and the patient died in eight hours. 
Unable to obtain post-mortem. 

Appendix, Walls greatly thickened ; small fecal concretion in tip 
of appendix ; a much larger one near the coecal end ; two small per- 
forations in the distal end ; long meso-appendix. 



Report of a Case of Lumbar Nephrectomy. 

BY JOHN C. MCCOY, M.D., PATERSON, N. J. 

The following case of nephrectomy for abscess of the kidney pre- 
sents several points of particular interest. First, the source of infec- 
tion ; second, the extreme dilation of the ureter, and thirdly, the 
evidently prolonged duration of the trouble with the accumulation of 
pus in the kidney, and the absence of a febrile condition, as at no 
time during the six months I had known patient, had she, to my 
knowledge, had a temperature above 99* F. The history is as 
follows ; Mrs. V., widow, age 42 ; family history negative ; menstru- 
ated first when fourteen years of age ; menstruation was regular from 
this time up to the first appearance of the present trouble ; has never 
been pregnant. She was perfectly well up to ten years ago, when she 
noticed that her menstrual periods became more profuse than usual 
and the intervals between the periods were shorter than previously. 
Two years later she was examined and told, " There was a tumor in 
the uterus," and various treatments, including the application of 
electricity, were resorted to. The growth steadily increased in size, 
but the "floodings " and frequent menstruations subsided about two 
years ago. Shortly after this the patient had an attack of severe 
abdominal pain, which confined her to bed for some little time. She 
says the pain at this time was confined largely to the lower abdominal 
region, and during this attack she was nauseated the greater part of 
the time. About six months after this trouble she noticed that her 
urine was passed more frequently ; that there was pain during the 
urination and a considerable deposit of pus in the vessel. Lavage of 
the bladder was instituted at this time and continued for several 
months, and during this treatment the bladder symptoms partially 
subsided, but at no time since they first appeared has the urine been 



I70 MEDICAL SOCIETV OF NEW JERSEY. 

perfectly clear. During the past two years it has been necessary to 
use a rectal enemata, and by means of the finger in the vagina, lift the 
uterus up, in order to obtain a satisfactory evacuation of the bowels. 

Physical Examination. — Poorly nourished and anaemic; the 
skin over the entire body is mottled with brownish colored spots, 
varying in size from a pin-head to a silver half dollar, those on the 
face being larger than elsewhere on the body ; heart and lungs nega- 
tive. Bi-manual palpation elicited a mass occupying the hypo-gastric 
and both iliac regions, extending to the umbilicus. The mass was 
irregularly nodulated and freely movable. On deep palpation there 
was some pain in the right iliac region and marked pain just below 
the free border of the ribs on the right side. 

Examination of the Urine.— Amount voided in twenty-four 
hours, fifty ounces ; reaction, acid ; albumen, a trace ; pus cells in 
abundance ; temperature 99® F. ; pulse 1 1 5 and of poor quality. The 
patient's condition seemed so bad that an operation appeared out of 
the question. She was, therefore, sent into the country and placed 
upon a general tonic treatment, under which she improved slightly. 
On May 15th, 1898, Dr. Howard A. Kelly, of Baltimore, did ahystero- 
myomectomy upon the patient, the growth which was removed 
weighing six pounds and seven ounces. 

At the time of the operation the vermiform appendix was found to 
be the seat of an old inflammator>' trouble, and at its distal end was 
intimately adherent to the anterior surface of the ureter, which latter 
was enlarged to the size of an adult thumb. About two inches from 
the bladder there was a marked constricture of the ureter, it being at 
this point no larger than a goose quill, the dilation from this point up- 
wards becoming more marked and finally terminating in the greatly 
distended pelvis of the kidney. The kidney itself was about twice its 
natural size and was felt to be distinctly fluctuating. Dr. Kelly 
removed the appendix, but, owing to the patient's condition, it was 
deemed inadvisable to operate upon the kidney at this time. Conval- 
escence from the hyster-myomectomy was uneventful, the patient's 
temperature only once reaching 100® F. 

While the temperature remained normal the pulse still kept at from 
100 to 120, and the patient complained of considerable pain in the 
right lumbar region which was greatly aggravated by palpation just 
under the free border of the ribs. Examination of the urine at this 
lime gave the following results : Amount voided in twenty-four 



Kidney. 



:y, actual size, a, i. c. locations at which small portions ofthe 

SUBCORTICAL KIDNEY TISSUE REMAINED, 



APPENDIX TO THE MINUTES. 173 

hours. 42 ounces ; reaction, slightly acid ; pus cells abundant ; albu- 
men, a trace. 

On June 5th the patient was placed under chloroform and a cysto- 
-scopic examination of the bladder was made. The mucus membrane 
of the bladder was considerably hypertrophed and the blood vessels 
prominent, this condition being particularly marked upon the right 
side. There was an area an inch in diameter surrounding the right 
xireteral orifice, where the mucus membrane was considerably more 
thickened than elsewhere ; pus could be distinctly seen dropping from 
the right ureteral orifice, bathing this inflammed area, I was able to 
pass a No. 2 flexible ureteral catheter into the right ureter for a 
distance of two inches, when an obstruction was met with which it was 
impossible to pass. Examination of the left ureter was negative. 

Lumbar Nephrectomy. — ^June 15. Incision beginning at the outer 
margin of the erector-spinse muscle, passing under the twelfth rib to 
the axillary line; the quadratus-lumborum muscle drawn inward 
•exposing the transverse fascia which, when divided, brought into view 
the peri-renal fat ; blunt dissection exposing the enlarged kidney, 
which was intimately adherent to t he adjacent tissues. These adhesions 
were broken up by the (inger, and the ureter could be readily palpated 
-for several inches below the pelvis of the kidney. The renal vessels 
were ligated with silk, the ureter drawn upward and ligated at the 
lowest possible point. A second ligature was applied just above the 
first and the ureter divided between these. The stump of the ureter 
^was then cauterized with pure carbolic acid, a suture passed through 
the stump attaching it to the pelvic muscles, a drain of iodoform 
gauze was passed down to the bottom of the cavity, and the central 
portion of the wound left open. 

Recovery was uneventful. There was no rise of temperature and 
the pulse, which for months previous to the operation had ranged 
from 100 to 120, in two days dropped down to 78. The pus dis- 
appeared almost entirely from the urine. The packing was removed 
from the wound on the second day. The patient left the hospital in 
fourteen days after the operation, and at the present time the wound 
is rapidly filling up. 

The Kidney consisted of a mere shell formed by the cortical 
portion of the kidney which was about an eighth of an inch in thick- 
ness, the cavity being filled with pus and broken down tissue. On its 
upper surface there were three small areas where there was a small 



174 MEDICAL SOCIETY OF NEW JERSEY. 

amount of subcortical renal tissue. The pelvis of the kidney, as 
shown in the specimen, was enormously distended and the upper 
portion of the ureter greatly distended and convoluted. The section 
of the ureter shows the greatly thickened 
posterior wall and the comparatively thin 
anterior wall, the posterior wall being nearly 
three times as thick as the anterior. 

Taking into consideration the attack of 
severe abdominal pain which the patient 
had experienced two years previous, which 
was probably an attack of acute appendi- 
ceal trouble, together with the pathological Section of ureter, actual size, 

changes found at the time of the abdominal *^°^*"« '^""^"^ P"*'"°" 
section, it seems fair to presume that the 

contact of the appendix with the ureter had set up the ureteritis, and 
the direct extension of the trouble to the kidney, by means of the 
ureter, was the cause of the pyo-nephrosis. 




Report of a Case of Foreign Body in the: 

Bronchi; Tracheotomy. 

BY WALTER B. JOHNSON, M.D., PaTERSON, N. J. 

On June 19th, 1897, baby, V. S., three and one-half years of age, a 
female, was admitted to the Paterson General Hospital, giving the 
following history. Upon the previous day, during the morning, she- 
was playing in the front of the house upon the piazza with a number 
of large beans. Her mother's attention was attracted by a series of 
strange sounds. She hastened to the front stoop and found the child! 
coughing and gasping for breath, black in the face, and, as she 
believed, choking to death. The family physician was immediately 
summoned, but before his arrival the choking had ceased, the child? 
became calm and was apparently suffering no discomfort. The- 
doctor made an examination and concluded that a foreign body had 
become engaged in the larynx but had probably been coughed out and 
swallowed. The child remained very comfortable, only being occa- 
sionally disturbed by a slight irritating cough; slept comfortably 
until three o'clock in the morning when she awoke suddenly from a. 



APPENDIX TO THE MINUTES. I75. 

profound sleep, coughing and strangling. This attack lasted ten or 
fifteen minutes and was almost as severe as the first seizure. 

The family physician was again called and after a careful examina- 
tion of the chest, thought he was able to locate a foreign body in the 
left lung, in the vicinity of the heart and advised that the child should 
be taken to Paterson and an effort made to locate the substance by the 
means of an X-Ray picture. He referred the patient to my friend Dr. 
Joseph A. Williams, who recognizing the impossibility of the bean, if 
such were the foreign body, showing in a radiograph, referred the 
case to me. Upon examination I found the child suffering from fre- 
quent spasmodic cough, markedly increased in the recumbent position. 
She was very restless and pettish. There was almost complete loss 
of the respiratory murmur over the lower portion of the left lung and 
crepitant and sub^-crepitant rales over the upper portion of the lung 
and loud moist rales over the larger bronchial tubes. On percussion 
there was normal resonance over the upper portion of the lung and 
tympanitic resonance over the lower portion on the anterior and pos- 
terior walls of the chest. The child had had, about one hour previous 
to her visit, a short choking spell. Her respiratory movement was 
accelerated, her pulse rapid, face flushed, hands and feet cold and her 
face presented an anxious drawn appearance. 

The child was recommended to apply at once for admission to the 
hospital and immediate operation was advised, but declined, the 
parents taking the child to the home of a friend in the city. At about 
six o'clock, on the evening of the same day, my fnend Dr. Williams 
was called to the house and found the child coughing and strangling, 
her face markedly cyanosed and her suffering more intense than in 
any previous seizure. He prevailed upon the parents to remove the 
child at once to the Paterson General Hospital. The patient after 
reaching the hospital was fairly comfortable under an opiate. Opera- 
tion was again advised and immediately undertaken. The child was 
^etherised ; a long cutaneous incision was made over the trachea ; 
the tracheal incision was then made, being about one inch in length, 
the idea being that if the foreign body could not be removed, the 
tracheal wall should be stitched to the skin and an ample opening left 
for its subsequent exit if disloged during expulsive coughing. 

The trachea was held open by forceps and a long, slender, duck- 
billed forceps was introduced to the bifurcation ; as a result of the 
irritation caused by its passage, a violent cough dislodged the foreign 



176 MEDICAL SOCIETY OF NEW JERSEY. 

body, which was grasped by the forceps and removed before it could 
be drawn back by the inspiratory movement into the smaller bronchi. 
The foreign body is an old-fashioned kidney bean which now, having 
dried, is very much shrunken, its original dimensions having been : 
Length, three-quarters of inch; breadth, five-sixteenths of an inch, 
and thickness, three-sixteenths of an inch. The operation being 
concluded, the tracheal walls were brought together and sutures were 
introduced, drawing the line of the cutaneous incision tightly together 
and not providing for drainage. 

The child made an uneventful recovery, the temperature never 
exceeding 100, the pulse 120, or the respirations 24. There was, 
immediately after the operation, considerable air forced out of the 
trachea and under the skin during the coughing. This emphysema, 
which extended about the neck and slightly down chest, lasted for 
three or four days. The wound healed by first intention, the sutures 
were removed on the fifth day and the patient discharged cured on 
the seventh day after the operation. 



Opening of Discussion on " Milk as a Food and 

AS A Means of Contagion.' 



«> 



BY RICHARD COLE NEWTON, M.D., MONTCLAIR, N. J. 

Since last June there has not been so material an addition to our 
knowledge of bacteriology as we could have wished. This is prob- 
ably not because there has not been considerable work done in this 
important field, but because the subject is so difficult that any con- 
siderable advance may take a longer period for its establishment than 
one year. I am pleased to observe that several of the ideas advanced 
in my paper read before you last year seem to have received con- 
firmation in various quarters, and all are agreed that the immense 
importance of the subject justifies almost any amount of time and 
labor which can be expended upon it. 

Keer ^ has followed Schwartz in advocating the milk of goats 
instead of cows for invalids and delicate children. He reiterates the 
statements of Schwartz, which are, that the milk of goats is of more 



APPENDIX TO THE MINUTES. \^7 

unifom) quality than that of cows, inasmuch as the former animal 
selects her food more carefully and avoids a great quantity of fluid. 
Goats can also be fed in the stable with the same ease and satisfaction 
as the cow. Keer's principal reason, however, for preferring goat's 
milk is, that the animal is immune to tuberculosis and therefore its 
milk cannot carry this disease and does not require boiling to render 
it innocuous. He has demonstrated in fresh, unboiled milk the 
presence of fat globules with granular contents which are immediately 
taken up into the blood to build up the cellular tissue. This constitu- 
ent of milk is completely destroyed by boiling. Boiling also so alters 
the fluid albuminoid constituent that it is difficult to dissolve and 
assimilate it in the alimentary canal. Keer is therefore persuaded 
that milk should not be boiled when its nutritive value is required. 
This phase of the infant food question I insisted upon last year. If 
the milk of the goat or the ass has all of the advantages over cow's 
milk which Schwartz and Keer, amongst modern writers, claim for it, 
our failure to make use of it in certain difficult cases of infant feeding 
is, I believe, unjustifiable. 

Concerning the great value of milk as a universal food, all writers 
seem to be pretty well agreed. Various experiments have recently 
been carried out in feeding milk to animals and the results have, as a 
whole, been unexpectedly successful. Skimmed cow's milk and whey 
have been fed to cows, pigs, horses, colts and lambs, and with success 
in all cases except the lambs, which did not seem to assimilate it. 

Alvord' says that the Cooperative Dairy Association, of Hamburg, 
is reported as feeding large quantities of skim milk to its working 
horses, with satisfactory results. Colts were fed at the Iowa Experi- 
ment Station with separated milk, with highly satisfactory results. 
Ten pounds of skim milk were found to be equivalent to one pound 
of grain. Our author continues: "A seemingly unnatural use for 
skim milk, but one which has been reported as satisfactorily practised 
in a number of places, is as food for milch cows. The milk is 
heated to 155** or 160® F., and rennet is added. While the milk is 
thickening an equal weight of chaff or finely cut straw is mixed in, 
and after being well stirred, it is allowed to stand two or three hours 
in a large tub or tank. The whole mass is then left to ferment from 
forty to forty-eight hours. It is claimed that, thus prepared, a gallon 
of skim milk amply replaces four pounds of concentrated grain food." 

In a paper read before the Indiana State Dairy Association last 



178 MEDICAL SOCIETY OF NEW JERSEY. 

winter, the advantages of feeding milk to hogs were set forth in a 
convincing way. One stockman is quoted as saying that in feeding 
ihogs milk as compared to corn he felt like the German who said that 
*• too much whisky is very bad, but too much lager beer is shust right." 
so too much CQrn is very bad, but too much milk is " shust right." 
He said that corn forced hogs too fast when fed exclusively on it — 
they grow fat and patchy and quit growing too soon, while milk made 
them not only eat more of their food but also helped the digestion, 
and so produced larger hogs and a more uniform high grade of pork. 
At the Wisconsin Experiment Station two sets of hogs were fed for 
a given time, the first on corn alone, the second on mill feed mixed 
with milk. Of the latter, the heart, lungs, kidneys and liver were 
from ten to fifteen per cent, heavier than those of corn fed hogs. 
They had more muscle and were in better condition generally. Their 
thigh bones, put into a testing machine, sustained a pressure of nearly 
1,000 pounds, while the thigh bones of the corn fed hogs were crushed 
at a pressure of 300 pounds. The writer of the paper asserted that 
he was running a small farm dairy of twelve cows. He shipped his 
-cream and fed the skim milk to the hogs, and made more money out 
of the milk fed to the pigs than out of the cream he shipped. He 
could not make the right kind of pigs without milk. He fed the milk 
sweet ; sour milk is not good for pigs. 

Of various other uses to which milk has been put recently we have 
Tiot time to speak at length. It is safe to say, however, that the use 
of milk as a valuable and economical food is gradually increasing, to 
the great benefit of those who consume it. There seems to be no 
•doubt that boat crews trained on milk can always outrow those trained 
on beer, and no doubt this superiority applies to race horses and milch 
cows also. It would seem that more attention should now be turned 
to the hygiene of the cow stable and the care and food of the animals 
themselves. An immense amount of effort must be expended before 
•dairymen can be persuaded that it is to their interest to study the 
manners and customs of the cow in her wild state, and learn more 
nearly how the health and vigor of the herd may be preserved. The 
modern tendency is doubtless to keep cattle in too large herds and to 
stable too many of them under one roof. I notice that a number of 
writers on the subject practically endorse the position which I took in 
my paper last year and insist that milk should be fed to children as 
soon as possible after milking. The milk laboratories seem to be 



APPENDIX TO THE MINUTES. 1 79 

Ihaving a struggle to exist and it appears doubtful whether they will 
•ever meet the expectations of their originators if, indeed, they can 
be kept open. 

The Pastuerization of milk, of which we were inclined to think so 
thighly last year, has met with considerable opposition. Amongst 
others. Dr. Koplik, of New York, has spoken against the process in 
no uncertain terms. I quote a few sentences : ** In his earliest 
experiments upon the subject of sterWzation, Pastuer convinced 
4iimself beyond any question that milk could not be sterilized at the 
temperature applicable to wine or other fluids— 60^ to 65** C. The 
process now called Pastuerization did not apply to milk. * ♦ ♦ and 
•did not obtain the sanction of the master whose name it bears." The 
great mass of summer diarrhoeas, the fatal g astro-intestinal disorders 
of infancy and early childhood, and some of the most troublesome 
diarrhoeas of the winter months are now generally conceded to be 
due to bacteria and toxins in the milk food of the infant. These 
bacteria and toxins are not destroyed or inhibited in growth by the 
process of Pastueration. Koplik relates that some specimens of 
Pastuerized milk, when examined, contained no bacteria, while others 
-contained 57,000 per c. c. The process is therefore, in his estimation, 
an uncertain and unscientific one. 

Most of the germs which exist in the milk which are harmful to 
infants and children and which are not affected by Pastuerization 
<iivide themselves into: a. The lactic acid forming group; b, the 
butyric acid forming group ; c, the peptonizing group of bacteria. 
The first group is very active in causing gastro-intestinal disturbance. 
The process of sterilization at 90** to 95*^ C. completely destroys these 
bacteria. The latter two groups cannot be destroyed by any process 
of sterilization at or below 100^ C. 

Dr. Koplik then recites a number of cases in which distinct symp- 
toms of milk poisoning supervened after the administration of pas- 
tuerized milk. He believes thoroughly in sterilized milk and asserts 
that the argument which was first raised against sterilization by Leeds 
and Davis, that the high heat lessened the digestibility of the milk by 
coagulating the albumens and changing them, has not been verified 
after years of work on this very theme. 

Morfan^ reports an epidemic in which a number of young children 
suffered from a severe gastro-enteritis, in which the milk had been 
sterilized sixteen hours after milking. 



l8o MEDICAL SOCIETY OF NEW JERSEY. 

And Prof. Staar' says, sometimes milk in every form and however 
carefully prepared, ferments soon after being swallowed and excites 
vomiting or causes great flatulence and discomfort, while it affords 
little nourishment. 

Luebbert* has isolated from milk which had been boiled, a bacillus 
which grew easily at body temperature on agar, serum and potato- 
and produced spores which were not killed by a temperature of boil- 
ing water for two hours. This bacillus when grown in milk did not 
alter the smell or taste, did not attack the sugar or fat, but peptonized 
the casein. Such milk produced violent diarrhea in young guinea 
pigs. In the healthy adult the gastric juice has an antiseptic action, 
and the stomach has been called a " sterilizing chamber," but Saltan 
Fen wick' concludes that in the infant it must rather be regarded as a 
natural form of incubator, in which every species of micro-organism 
that finds an entrance with the food, is afforded every facility for 
growth and multiplication.. As to the spread of infectious diseases 
by milk, there are some interesting cases to report. 

A small epidemic of scarlet fever in Montclair, N. J. and vicinity 
occurred in 1897. The cases numbered twenty primary and seven 
secondary (of the former, one died) and were nearly all amongst 
families supplied with milk from one dairy. This dairyman had 
bought milk from outside on one or two occasions and sold it to his 
customers, and it was supposed that some of this milk had been con- 
taminated with the scarlet fever germs. However, after the most 
careful search, no cause of contamination of the milk was found. 
Still, the health inspector believes that the milk of this particular 
dairyman was the vehicle of the scarlet fever contagion. There was 
recently, in Philadelphia, an epidemic of diphtheria along the milk 
route of one P. Brady. There were eighty-six cases with twenty-two 
deaths. The dairy was found in an unhygienic condition and the sale 
of milk from it was suspended. Great pains have been taken to 
demonstrate the presence of the Kleb-Loeffler bacillus in the milk, but 
with what success I have not yet learned. 

In certain dairies in Caldwell there has recently appeared an 
epidemic of vaccinia which spread quite rapidly and caused some 
inconvenience to the dairymen. The cows were isolated and the sale 
of their milk suspended. The dairymen and some of the veterinarians 
who examined the cows claimed that a majority of -the lesions were 
due to what they called feed boils, which are little abscesses which 



APPENDIX TO THE MINUTES. l8l 

• 

form upon the teats and in the udders when cows are turned out to 
grass after having been kept on grain and dry feed during the winter. 
The scabs and serum were removed from a number of the lesions and 
will, I understand, be carefully experimented with by Dr. Doty of the 
New York Board of Health and others'. What effect, if any, these 
lesions may have upon the milk and how long the cow should be 
isolated and her milk kept out of the market, do not seem to have 
been determined as yet. It is certain, we might remark in passings 
that the so-called feed boils need investigation and report, inasmuch 
as many observers seem ignorant of their etiology and pathology, and 
some were disposed to deny their existence. There is undoubtedly, 
however, such a condition of milch cows which appears more or less 
in the spring. 

In this connection I note the following interesting experiments of 
Boch and Welminisky* which were undertaken to show the effect of 
the presence of infectious germs upon the milk glands. They selected 
guinea pigs for experiment and took every precaution to render the 
glands and nipples thoroughly aseptic. They then injected cultures 
of anthrax, which killed the animals and did not infect the milk. 
When, however, they injected cultures of pus-forming bacteria into 
the veins, in from five to eight hours these organisms were present in 
the milk. In the cases of two women suffering from puerperal septic 
infection, streptococci were found in the blood but not in the milk. 
The writers conclude from their experiments that infectious germs 
which gain access to the milk do so simply by circulating through the 
glands in the blood stream, and that to enter the milk they must pass 
through the glandular substance through some injury. The question 
whether the milk of the infected animal is fit to use, must be settled 
for each case by a careful study of the individual patient. 

Drs. W. R. Stokes and A. Wegefurth**, of Baltimore, (the former 
is the bacteriologist of the health department) recommended regular 
microscopic examinations of milk to detect pus. This may be present 
from a disease of the cow's udder called garget, which is not very in- 
frequent. These writers believe that they were able to trace a series of 
cases of mild gastro-intestinal irritation to purulent infection of the 
milk. They suggest that milk be rejected when over an average of 
five pus cells be found on the field of a one-twelth inch oil immersion 
lens. An extensive epidemic of typhoid fever in and about Paterson 
was traced to the dairy of a man named Fullboan. However, of this 

IS 



1 



1 82 MEDICAL SOCIETY OF NEW JERSEY. 

particular epidemic, Dr. Leal, of Paterson, has promised to speak in 
extenso. With the study of the subject of the conveyance of tuber- 
culosis by milk there has been some advance made. 

At a meeting of the Society de Biologie de Paris, April 23, 1898, 
M. Sabrazds, of Bordeaux, presented a communication illustrating the 
fact that cows' milk very often contains tubercle bacilli and that 
such milk plays a great part In the transmission of tuberculosis from 
animals to man. He had undertaken experiments to determine 
whether the tubercle bacillus can form a colony in the milk under con- 
ditions favorable to its growth, and whether it preserves its virulence 
in this medium for a considerable time. The experiments led to the 
conclusion that the tubercle bacillus does not develop in milk even 
under favorable circumstances, but that it may remain alive and viru- 
lent, when it has found its way into milk, for at least two months and a 
half, and probably also much longer. 

A Dr. Trent, writing to the Medical Record ^ ', claims that tuberculosis 
in milch cattle is chiefly due to over-milking and urges that the law 
should compel every farmer and dairyman to allow his cows to go 
dry for the last three months of gestation. 

Obermuller^ * has found Koch's bacilli in butter. Fourteen speci- 
mens were obtained from the Berlin markets and all of them gave 
rise to tuberculosis in guinea pigs. Whereas. Miss Lydia Robiniovitch 
having examined eighty specimens of butter from different shops and 
markets did not discover the bacillus in a single one. 

Dr. Brush ^' states that he (irmly believes that all the tuberculosis 
afflicting the human race comes from the dairy cow, either directly or 
indirectly. And Mr. Nathan Strauss, of New York City, has un- 
■doubtedly saved the lives of thousands of infants by supplying 
sterilized milk at cheap rates. In fact, thanks to the untiring efforts 
•of men like our Dr. Coit, it is getting to be the fashion to work and 
write and spend money for the sake of obtaining wholesome, germ- 
free milk. Even a Tammany brave is reported to have said, after he 
had been appointed a sanitary inspector in New York City, that he 
•expected to make twenty thousand dollars by admitting rotten meat, 
vegetables and fish into the city, but he was going to get up a ** hell 
•of a reputation " by shutting out impute milk. 

Before closing, I would remind the Society that eternal vigilance is 
the price of wholesome food products of all sorts. I am disposed to 
agree with Dr. Rosa Engelman,^^ who says it is a well-known fact 



APPENDIX TO THE MINUTES. 183 

that the lack of food and dairy inspection laws, lax laws and the 
improper enforcement of the same, account for the presence of from 
thirty to fifty per cent., even up to seventy per cent., of the tubercu- 
losis which is present in dairy stock and cattle. She quotes the 
English authority, Burden Sanderson, who says that one-third of all 
the children who die in the hospital die of tuberculosis. The mortality 
in children due to this cause is, according, to the same author, from 
thirty-five to forty per cent. An undetermined proportion, but prob- 
ably a majority of this appalling mortality is due to milk infected by 
the tubercle bacilli or its toxins. Nor does cooking t^e milk, as we 
have just shown, entirely remove this danger. Artificially fed children 
can never be safe from " the great white death " until tuberculosis is 
stamped out of all our dairy herds. 

To this end, Mr. President and fellow-members of the Medical 
Society of New Jersey, let us never relax our efforts until proper and 
sufficient dairy laws are enacted and enforced. My investigations into 
dairy methods have led me to the discovery of a custom so mean, so 
revolting and so devilish that I cannot refrain from speaking of it, 
although it does not strictly come within the scope of this paper. I 
refer to the sale of the bodies of dairy animals which have died of 
disease or accident, to the bologna man. I find that this reprehensible 
practice obtains in even the better class of dairies, and would suggest 
that the dealer in Bob veal is a philanthropist in comparison with the 
bologna sausage man. It is to be hoped that by setting the seal of 
its disapproval upon this practice our Society can effectually prevent it. 

I would therefore urge upon this Society several very important 
amendments which we need in our sanitary legislation. First. — Let 
us have a law that all milk venders whatever, shall be obliged to take 
out a license. They shall present with the application for a license, a 
statement, properly sworn to, of the condition of their herd, source of 
water supply, method of feeding, housing and caring for their stock, 
method of handling milk, etc., etc., and the health inspector shall be 
obliged to verify every item of the statement before the license shall 
issue. And the said license may be revoked at any time when the 
conduct of the dairy shall fall below the recognized standard. Second. 
— The license shall be revoked whenever the dairyman shall fail to 
give notice of any case of sickness amongst his cattle or his family or 
employees. Third. — The testing of all milch cattle with Koch's tuber- 
culin shall be compulsory. Fourth. — The selling of the bodies of 



I84 MEDICAL SOCIETY OF NEW JERSEY. 

cattle which die from diseases or accident or which are in too poor 
condition to be sold to a regular butcher, to bolog^na sausage men, 
shall be a misdemeanor punishable with fine and imprisonment. 

BIBLIOGRAPHY. 

1. Medical Record. Oct. i6, 1897. 

2. Alvord. Year Book, Department of Agriculture, 1897. 

3. Medical Record, Feb. 19, 1898. 

4. American Medical and Surg. BuL, June 25, 1897. 

5. American Text Book, Diseases of Children, p. 28. 

6. The Year Book of Treatment, 1898, p. 150. 

7. Disorders of Digestion in Infancy and Childhood, London, 1897. 

8. Philadelphia Medical Journal, May 21, 1898, p. 915. 

9. Amer. Journal Medical Sciences, March, 1898, p. 366. 

10. Journal Amer. Med. Asso'n, Oct. 9, 1897, p. 749. 

11. N. Y. Med. Journal. Nov. 6, 1897, p. 640. 

12. N. Y. Med. Journal, Aug. 14, 1897, p. 222. 

13. Medical Record, Nov. 6, 1897, p. 685. 

14. Jour. Amer. Med. Asso'n, June 18, 1898. 

15. Jour. Amer. Med. Asso'n, May 21 and 25. 



Milk. 

BY JOHN L. LEAL, M.D., PATERSON, N. J. 

First, as a food. Second, as a bacterial culture medium. Third, as 
a carrier of infection. 

MILK AS A CARRIER OF INFECTION. 

I have been requested by the committee having in charge the pro- 
gramme of this meeting, to open the discussion on the subject of milk 
as a carrier of infection, and to illustrate said subject by the history 
of two or three epidemics which have come under my personal observ- 
ation. The subject is not only an interesting but also a very volu- 
minous one. Coming as it does as only a sub-head under the head of 
" Milk," time will not allow me to make more than a brief statement 
of present opinion on the subject. That opinion may be summed up in 
the following propositions : First. — That milk is a carrier of infection, 
more so than any other one article of food. The theoretical and scien- 



I 



APPENDIX TO THE MINUTES. 1 8$ 

tific basis of this proposition will be explained by the gentleman who 
will discuss milk as a bacterial culture medium. Its truth is established 
by a vast mass of evidence which has been accumulated by practical 
experience. Second. — That the diseases, the infection of which is 
certainly carried by milk, arc typhoid fever, cholera, tuberculosis, 
diphtheria and scarlet fever. This statement, in so far as it relates to 
scarlet fever, is based upon analogy and practical experience. Milk is 
also capable of developing and maintaining the vitality and the viru- 
lency of certain groups of bacteria, the presence of which give rise to 
intestinal irritation. Besides, though not proven, it is considered 
scientifically possible and practically probable that the infection of 
small-pox, typhus fever, tetanus and malaria may be conveyed through 
this means. 

Now, as to the common methods of infection of milk by typhoid 
fever, cholera, tuberculosis, diphtheria and scarlet fever. 

By diphtheria and scarlet fever, ist. Through exposure to infected 
air. This air may have become infected through some patient suffer- 
ing with one of these diseases, or indirectly through some person or 
thing thus infected. 2d. Through exposure to infection in the 
handling, directly or indirectly; directly through handling by some 
person or persons Offering with these diseases at the time ; indirectly 
through some person or persons, dishes, containers, apparatus or 
utensils which have become infected by such person or persons. 

By tuberculosis, ist. Through exposure to infected air; this air 
containing dust formed in part of dried tubercular sputum. 2d. 
Through direct infection from some person or persons suffering with 
the disease, as by particles of expectoration flying into exposed milk 
during an attack of coughing, by handling with infected hands, etc. 
3d. Through some person or persons, dishes, containers, apparatus or 
utensils infected directly by some person or persons suffering with the 
disease, or indirectly by infected dust, etc. 4th. Through cows having 
tuberculous udders. 

By typhoid fever and cholera, ist. Through the intentional or 
accidental addition of infected water. 2d. Through handling with 
hands infected by discharges or water. 3d. Through dishes, con- 
tainers, apparatus or utensils infected in handling or by water. 4th, 
In the case of typhoid fever, infection through infected ice. 

It follows from the above that certain rules must be carefully 
observed in order to prevent milk from acting as a carrier of infection. 



I86 MEDICAL SOCIETY OF NEW JERSEY. 

1st. That milk for food purposes must be taken only from healthy- 
animals. 2d. Every precaution must be taken to prevent exposure to 
air which by any possibility could be infected. 3d. Those handling 
the milk must not only be personally free from these diseases, but 
must also be protected from infectidn through others. 4th. All 
premises, dishes, containers, apparatus and utensils' must be guarded 
from infection through persons, air and dust. 5th. All water and ice 
used in connection with milk must be free from infection. 

That these rules should be properly carried out is of vital import* 
ance to the consumer and of much interest to the profession, the 
function of which is not only to cure disease but also to prevent it. 
Unfortunately, however, the producer does not always look at the 
matter from our standpoint, and is apt to resent as interference with 
personal and property rights our well-meant efforts in this direction. 
The only solution of the difficulty is the wider dissemination of know- 
ledge upon the subject, and therefore the better education of the 
people, which must come through the medical profession. 

FIRST PRACTICAL ILLUSTRATION. 

In October, 1889, thirty-four cases of typhoid fever were reported 
to the Board of Health of Paterson. Investi^tion showed that 
twenty-seven of these cases were supplied with milk from the same 
dairy. Further investigation by my friend, Dr. William K. Newton, 
then State Dairy Commissioner, and myself, disclosed the following 
facts : Said dairy was situated in an out-lying township. The water 
supply was from a spring in the milk house, which was distant from 
the other farm buildings about two hundred yards, and out of the 
direct line of drainage, and from a well in the barn yard. The well 
was so situated as to receive the general barn drainage as well as 
that of an immense pile of manure placed within 1 5 feet of it and in 
the direct drainage line. Chemical examination of the water supply 
showed the water of the spring to be pure and that of the well to be 
badly contaminated. The dairy people declared that neither the milk, 
the cans, the dishes or the utensils came in contact in any way with 
the water of the well. That the coverfuU of water which they 
admitted putting in each can of milk ** for the purpose of preserving 
it," came from the spring, and that the cans, etc., were washed with 
the same water. They denied ever having anything connected with 
the milk business anywhere about the place except at the milk-house. 



APPENDIX TO THE MINUTES. 1 8/ 

That water from the well was only used for drinking purposes by the 
men employed about the barn, and for washing purposes about the 
house. We also found that on (he 14th of the preceding month a 
stranger from Pennsylvania had been employed about the place. He 
had complained from the first of not feeling well, suffered from fcver» 
diarrhoea, headache, prostration, etc. He held out until the 25th, when 
he was forced to return home. On the 5th of October, another man 
who had been employed upon the place steadily for two years, became 
ill about the same way and left on the 12th to enter the hospital. Our 
twenty-seven cases in the city using this milk all developed between 
Oct. 2d and 24th. We succeeded in locating the two employees — 
one in the Bethlehem, Pa , hospital, the other in the Paterson General 
Hospital — both suffering with typhoid fever. We also found that 
both these men while ill on the place had been in the habit of using 
the manure pile, which drained into the well, as a convenience. It was 
easy for us to reach the conclusion that the man had been a walking 
case of typhoid ; that through his use of the manure pile he had in- 
fected the well, and that the second man had become infected through 
drinking the water of said well. The difficulty was to connect the 
infection with the milk, as according to all the evidence obtainable, 
neither man had anything whatever to do with the milk business. 
The missing link was found, however, when a female servant con- 
fessed that she had been in the habit of washing the can covers with 
water from the well. The well was filled up on the 16th and no cases 
developed after the 24th. 

SECOND PRACTICAL ILLUSTRATION. 

The average number of cases of typhoid fever in Paterson during 
the months of November and December for the six years preceding 
thai of 1896, when we were in the midst of a general epidemic due to 
an infected public water supply, was during November, 8 cases, and 
during December, 5 cases. During the first half of November, 1897, 7 
cases of typhoid were reported to the board of health. From the 1 5th 
of November to the ist of January, 1898, 142 cases were reported. 
All of these 142 cases became ill between November 5th and Decem- 
ber 15th. All but five became ill between November 14th and Decem- 
ber 1 5th. The number of these cases in well-to-do families was far out 
of proportion considering the character of our population. Ninety-nine 
of them received their milk supply from a certain creamery for all or a 



1 88 MEDICAL SOCIETY OF NEW JERSEY. 

portion of the fifteen days preceding the commencement of their 
illness. Of the forty-three cases left, fourteen had used cream, or 
ice cream or soda water containing cream, from the same creamery, 
on one or more occasions between the 1 5th and 5th days preceding 
their illness. Thus of the 142 cases developing between November 
5th and December 1 5th, only twenty-nine could not be connected 
'with the product of said creamery. 

The natural conclusions to those who have had experience in tracing 
epidemics due to milk, and understand its difficulties, is that at least a 
portion of these twenty-nine cases could have been connected if it had 
been possible to have obtained the facts in every case. Among the 
handlers of the milk in town, or among their families, were eight cases 
of the fever. In the Paterson Orphan Asylum, which was the only insti- 
tution supplied with milk from said creamery, there were nine cases 
among the seventy-odd inmates. On the 29th of November I became 
convinced that everything pointed to the milk as the source of infec- 
tion, and therefore telegraphed to Dr. Henry Mitchell, Secretary of the 
State Board of Health, requesting that he have an investigation made of 
the state of affairs at the suspected creamery. Such investigation was 
made by Dr. A. C. Hunt, State Inspector, on December ist. During 
the evening of the same day he reported to me a very suspicious con- 
dition of affairs existing there. He had been unable to find any possi- 
ble source of infection outside of the creamery. At the creamery 
he had found that water from a brook was pumped into the cream- 
ery for general use, through a pipe, the intake end of which was from 
1 15 to 130 feet below the privy belonging to the proprietor's residence, 
which privy overhung said brook. Four or five other privies were 
situated upon the banks of the same brook within an eighth of a mile. 
He also was informed that the three sons of the proprietor were ill in 
the house with remittent fever. He at once ordered the pipe taken 
out. 

At Dr. Hunt's request, I accompanied him on December 2d for the 
purpose of making a more thorough inspection. I found the creamery 
situated upon the bank of a brook. The premises consisted of the 
creamery, stable, ice house, cheese house and residence. The privy 
overhung the brook about one hundred feet above the creamery and 
was directly in the rear of the cheese house and residence. The water 
supply to creamery was, first, from the brook through a pipe as 
described above, which pipe had been removed before my arrival. 



APPENDIX TO THE MINUTES. 1 89 

according to orders given the day before by Dr. Hunt, and second, 
from a spring in the cellar of the cheese house through another pipe. 
The water supply of the cheese house was from the spring in the 
cellar and the residence was supplied from the same source through a 
pipe by means of a pump. The house drain, a wooden box. passed 
through swampy and made ground at a higher level and about fifteen 
feet above said spring, entering the brook a few feet above the privy. 
We found thai the creamery received the milk of fifty-three dairies 
and that said milk was all handled at the creamery and sent to Dover, 
Morristown. Paterson, Newark, Arlington, Jersey City and New York. 
Inquiry from physicians, the creamery proprietor, and other residents, 
failed to give any clue to suspicious illness at any of these dairies. I 
will here state, on the authority of the State Dairy Commissioner, that 
all of these dairies were afterwards inspected and no source of infec- 
tion found. 

The three sons of the creamery proprietor were visited, examined, 
and found to be sufiFering with typhoid fever. In this diagnosis both 
Dr. Hunt and the attending physician concurred. Their temperature 
varied from 102 to 10$ ; the typical tongue, erruption and diarrhoea 
were present; they suffered from nose bleed and presented the 
abdominal symptoms. Not a single important symptom of typhoid 
was absent except intestional hemorrhage, and I am informed by Dr. 
Hunt that two of them afterwards suffered from that condition. Dr. 
Richard N. Connolly, of Newark, also produced the Widal reaction 
in specimens of blood taken from said patients, and isolated the 
bacillus of Eberth in a specimen of water taken from the cooling vats 
in the creamery. Taken all in all, considering the arrangement of the 
premises, the privy, the house drain, the water supply, the milk 
handled upon the premises, the presence of the three cases of typhoid, 
a better illustration for a lecture upon '* How our milk supply might 
become infected by typhoid." I can hardly conceive. 
• The history of the three cases was as follows : George, aged 20, 
lived in New York City, in the milk business. He began to be ill 
about October 17th. Symptoms: Headache, chilly sensations, fever, 
alternate diarrhoea and constipation, nose bleed. While still attending 
to his business, but owing to his illness, he fell and injured his head. 
He went home October 27th and returned to New York November 3d, 
somewhat better but still ill. Became worse, same symptoms, sup- 
posed to be suffering with malaria and treated for same with quinine 



igO MEDICAL SOCIETY OF NEW JERSEY. 

and calomel. Went home again and to bed, November 29th. Was 
suffering with typhoid fever at the time of my visit, December 2d. 

William, aged 17, lived home and worked in creamery; became ill 
a few days before, but was forced to give up work November 14 ; 
was suffering with typhoid fever at the time of my visit, December 2. 

Otto, aged 1 5, schoolboy, became ill a few days before, but was 
forced to leave school November 23 ; was suffering with typhoid fever 
at the time of my visit, December 2. 

My theory is that George was a " walking case " of typhoid ; that 
during his visit home, October 27 to November 3, he infected either 
the brook or the spring, or both ; that the milk became infected 
through the infected water, and in its turn infected our Paterson cases. 
William and Otto may have been infected by either the milk or the 
water. At the time of my visit, December 2, I am of the opinion that 
George was suffering from a relapse of typhoid. We might, perhaps,, 
explain our cases by infection through William, granting that he was 
ill sufficient time before he was obliged to give up work, but then we 
know of no way in which William could have been infected at home 
except through George ; and besides, we would be obliged to accept 
the strange coincidence of one brother, living in New York, going 
home ill with typhoid and finding his two brothers ill there with the 
same disease. 

I have already stated that milk from said creamery was shipped to- 
Dover, Morristown, Newark, Arlington, Jersey City and New York, 
as well as to Paterson. I have no information from Dover or Morris- 
town, but am informed by health officials of the other cities as 
follows : Newark, unknown number of cases among those using 
milk from said creamery. Arlington, seventeen cases and six sus- 
pected cases became ill about November 20 ; all except one used milk 
from said creamery. Jersey City, thirty-five cases taken ill November 
15 to 20; twenty-four used milk from said creamery. New York,, 
nine cases found among those who had used said milk. 

THIRD PRACTICAL ILLUSTRATION. 

A small outbreak in connection with this greater one may possess 
some interest. A farmer in an adjoining township ran a milk route 
in Paterson. His supply was from his own cattle. Running short 
on the 13th, the i9ih and the 27th of November, he supplemented his 
supply with milk from the before-mentioned creamery. Between 
December ist and loth his son, living with him, and five of the patrons 
of his milk route in Paterson developed typhoid fever. 



APPENDIX TO THE MINUTES. IQI 

FOURTH PRACTICAL ILLUSTRATION. 

On January i, 1898, a milkman living and doing business in Pater* 
son, became ill ; was supposed to have malarial fever and was treated 
for same. On January 9 Dr. John C. McCoy was called in and found 
him suffering with typhoid fever. In the interval between the ist and 
the 9th he had continued at his business, personally engaging in 
bottling and otherwise handling his milk. Dr. McCoy, at his visit on 
the 9th, at once ordered the patient to bed and thus broke up his 
connection with the business. Between January 1$ and February i, 
twenty-seven cases of typhoid fever developed in town ; nineteen of 
these cases were supplied with milk by said milkman during that 
period of his illness between January i and 9. The outbreak ceased 
suddenly here, only four scattering cases developing during the whole 
month of February, and these having no connection with said milk. 

One of this series of cases was especially interesting. I personally 
attended the case and established the facts beyond the shadow of a 
doubt, the patient himself being a physician and his attendants more 
than usually intelligent. On the morning of January 2, the doctor's 
usual milk supply failing him, the deficiency was supplied from the 
establishment of said milkman. It was the first and only time that 
his milk had been obtained at that place. The doctor used said milk 
upon his oatmeal and drank two glasses of it. On the 1 5th of January 
he became ill with what proved in a few days to be typhoid fever. 

There are doubtless many others here present who can relate to 
you instances in which infection has been carried by milk and establish 
the same by inconvertible proof. Every such instance thus established 
should strengthen us in our endeavors to safeguard our milk supply. 
There is no other one article of our food supply which is more valu- 
able, which is more capable of harm, and which requires more watch- 
ful and constant care. Ignorance and selfishness should not be 
allowed to stand in the way of our exercise of the right of self- 
protection. Thousands of lives are lost every year through want of 
that constant and watchful care. The general public is dependent 
for its safety in this respect upon the medical profession. That 
responsibility must be met. We, as an organized profession, should 
insist that the State throw around this product of such vital import- 
ance, every protection which science and experience teaches to be 
effective. 



ADDRESS OF THE PRESIDENT, 

By David C. English, M.D.. New Brunswick, N. J. 



It affords me great pleasure to congratulate the mem- 
bers on this I32d Anniversary of the Medical Society of 
New Jersey, and also to extend a most hearty welcome 
to our visiting brethren from kindred societies, and the other 
friends who have honored us with their presence. I also- 
take this occasion to express again, to the members of the 
Society, my high appreciation of the distinguished honor 
conferred upon me and my thanks for the same, esteem- 
ing it the more as I recall the fact that this is not only 
the oldest medical society in the country, antedating the 
existence of our Nation by ten years, but that it has a 
record that is surpassed by none in devotion to the high-^ 
est interests of the profession, in loyalty to the State and 
in obedience to the sacred behpsts of humanity. 

During the year in which I have held the high trust 
with which you have thus honored me, it has devolved 
on me to exercise an authority which the late revision of 
our By-Laws vested in your presiding officer, for the first 
time in the Society's history — that of the filling of 
vacancies occurring in the offices. I need not assure you 
that the first performance of the duty thus imposed was 
a sad one, as it came in the providence of God through 
the removal, by death, of one of our most faithful and 
beloved members, whom you honored in his election as 
Third Vice-President of this Society at our last annual 
meeting, and who would have reflected honor upon the 
Society in his official position as Vice-President, and ia 
regular course as our President — John J. H. Love, M.D., of 
Montclair. Being an officer of the Society it was eminently^ 



194 MEDICAL SOCIETY OF NEW JERSEY. 

proper that official action should be taken, and I appointed 
a committee to represent the Society at his funeral service. 
Your President decided to choose his successor from the 
district society with which our deceased officer was con- 
nected, and he had no misgivings as to the approval of 
the members of this Society, or the proprieties of the 
situation, when he appointed the beloved and closest 
friend of Dr. Love — William Pierson, M.D., of Orange, 
as Third Vice-President. In accepting the office Dr. 
Pierson resigned the Recording Secretaryship, which he 
had most faithfully and acceptably filled for 31 years. 
Again it was deemed best to select from the society to 
which the former incumbent belonged, his successor, and 
William J. Chandler, M.D., of South Orange, who had 
faithfully attended and served our Society and was 
thoroughly qualified for the position, was appointed 
Recording Secretary for the unexpired term. 

I would announce to the Society the death of Dr. H. 
A. Buttolph, an honorary member of this Society , elected 
in 1854, a distinguished alienist, who was Director of the 
State Hospital for the Insane, at Trenton, for many 
years. Several of our prominent and able members have 
also departed this life since we last met, concerning 
whom our Standing Committee will report ; an outline 
of their lives and work will be recorded in our Transac- 
tions and their memories will be cherished. 

Your President had the pleasure and honor of represent- 
ing this Society at the semi-centennial celebration of the 
Mercer County District Medical Society last month. It 
was a most interesting and enjoyable occasion, on which 
the excellent work of that society was appropriately set 
forth, and the signs of an even more faithful and success- 
ful future were apparent. 

According to the usual custom, your President is ex- 



APPENDIX TO THE MINUTtS. I95 

pected to address you on such theme pertaining to the 
medical profession as he may deem proper. While 
-conscious of my inability to instruct or entertain you, I 
do indulge the hope that I may awaken your thought on 
the subject chosen, and that we may all have our mem- 
ories of the past refreshed, our love for our profession 
and our Society quickened, and our devotion as medical 
men to our country in the service of God and humanity 
stimulated. With these ends desired I have selected as 
the subject, 

PATRIOTISM IN THE MEDICAL PROFESSION, 

as exhibited in the past, and as it may find fuller, deeper 
and truer expression in the time to come. 

Patriotism is too often associated with a blind loyalty 
to the government and a submission to, or at least 
support of, the powers that be, regardless of any policy 
they adopt, right or wrong, as exhibited by many of the 
colonists in our early struggle, and they were called 
"*' loyalists ** because they adhered to the crown of Great 
Britain during the Revolutionary War; or loyalty to 
party or institution as illustrated during the War of the 
Rebellion. When, in the first instance, true patriotism 
required resistance to a government which had become 
oppressive and cruel toward its subjects, and in the 
second case patriotism required the laying aside of all 
party fealty in the maintenance of the Union. There is 
a higher form of patriotism, which exalts as its leading 
and greatest aim the building up of the National life 
when there is no war, the advancement of the country in 
material and moral prosperity and power, and the in- 
crease of her influence among the nations, and the 
greatest good of its citizens, in the securing and main- 
taining of their inalienable rights to ** life, liberty and the 



196 MEDICAL SOCIETY OF NEW JERSEY. 

pursuits of happiness," even if, for the accomplishment 
of these purposes, change of rulers must be resorted to 
by peaceable means through the suffrage of its citizens or 
by revolution if it must needs be. History affords many 
examples of this change in form of government or in the 
methods of its administration, both by peaceable and 
forcible means. 

But the highest of all conceptions of patriotism is that 
which recognizes God as reigning supreme, not only 
in the armies of heaven but also among the inhabitants 
of earth, and that all human governments are ordained 
by Him for the manifestation'and accomplishment of His 
desire and purpose, for the blessing of humanity in the 
extension of peace and good-will to men, and which 
seeks to secure good men in office, good laws and their 
execution, the highest interests of their fellow-men, and 
thereby good and righteous government for the good of 
men and the glory of God. This is Christian patriotism^ 
loyalty to truth, and it is not that of a sickly sentimen- 
tality, but of courageous, heroic deeds. It is not bounded 
by geographical lines or governed by selfish considera- 
tions, for it recognizes the Fatherhood of God and the 
brotherhood of man, and yet the wider its sweep and the 
more unselfish its devotion, the greater will be its in- 
fluence at home. 

The love of one's country will be none the less ardent 
because of his desire that the blessings of civil and 
religious liberty which he enjoys in his own land, shall 
be extended to the oppressed of other lands, and when 
providence opens the way he will be ready to help 
the struggling to secure these inestimable blessings. 
This was the patriotism of the founders of our govern- 
ment, and, as we shall endeavor to show, of the founders 
and early members of the Medical Society of New Jersey, 



APPENDIX TO THE MINUTES. I97 

and which has been her glory thrpugh the 132 years of her 
history. 

We have, as a nation, passed through four wars of 
considerable magnitude. The first was fought to over- 
throw a tyrannical, oppressive government and to gain our 
rights as an independent nation. The second was en- 
gaged in to maintain our rights and our dignity as a 
nation that had proven her right of independence. The 
third, to protect our borders and for conquest that was 
justifiable for the maitnenance of peace on our borders. 
The fourth, to maintain the inviolability of the Union. 

These were all justifiable and events proved them 
providentially ordered and approved for the develop- 
ment of the national life and prosperity in the accomp- 
lishment of her great mission, and they were crowned 
with greatest success, not only in gaining the objects 
sought, but also God's higher purposes in the blessing 
of our country and making it in deed and in truth, **The 
land of the free and the home of the brave." The spirit 
of patriotism evinced in all these conflicts impressed and 
astonished the world, winning or commanding its respect 
and honor. 

We meet tonight while the fifth great war is in pro- 
gress. We have no regrets or apologies to offer, under 
the circumstances, for its existence. We believe it comes 
under what we have expressed as the highest conception 
of patriotism ; that it is a war for God and humanity. 
Not undertaken to secure or maintain our own rights or 
dignity, not for conquest and glory, but for the relief of 
our friendly neighbors, an oppressed, starving, helpless 
people, suffering and perishing at the hands of a 
cruel, tyrannical, treacherous nation that has learned little 
during the past 5c» years for its own or others good, and 
practiced less, and can today furnish no good reason for 
ts 



198 MEDICAL SOCIETY OF NEW JERSEY. 

its existence. And so we say this war, unlike our previous 
wars, though they were all right and proper, is an unsel- 
fish war, and that the spirit of unselfishness is the very 
soul and glory of patriotism. 

This is the professed patriotism of Christian England 
and America. Let us thank God when they prove true 
to their profession. It is our glory today that America 
leads. We looked with horror on the atrocities practiced 
upon the Armenians and with England's greatest states- 
man, the lamented Gladstone, censured Christian England 
and the other great powers for failing to put a stop to those 
shocking atrocities. Christian America, after exhausting 
all the resources of entreaty and diplomacy, proves faith- 
ful to her profession, and in the name of God and 
humanity, offers to sacrifice her resources of men and 
money as far as needful, to relieve the oppressed. With 
unquestioning faith in the God of nations, we affirm that 
there has been, there can be, no doubt as to the outcome 
of the contest. Unselfishness is ever crowned with 
victory and the highest rewards. As in other wars, 
unsought conquest may and glory must come, and 
America is destined to take her place at the head as the 
nation that stands for justice, righteousness and humanity, 
if we continue true to the God of our country and with a 
fervent patriotism seek her exaltation in righteousness. 

But our purpose is to consider patriotism as manifested 
in and by our own profession, endeavoring to show that 
in no class of our citizens has it had greater manifesta- 
tion or been exhibited with as much unselfish devotion. 
There has not been so much of that particular form 
which finds expression on the platform, in the convention, 
at the political meeting, in rhetorical speech or extravag- 
ant glorification, nor have its accomplishments and unsel- 
fishness and results been oft paraded in reports. Rather 



APPENDIX TO THE MINUTES. I99 

has it been by a quiet, unobtrusive, unostentatious, 
patient, plodding, daily and often self-sacrificing work, 
which has sounded no trumpets, looked for no reward, 
and secured little reward save that which comes from the 
consciousness of duty done and humanity helped. Like 
the Chinaman's description of the Americans when 
asked what he thought of the Spanish and the 
Americans in the present conflict, replied : ** The Spanish 
do a heap of talkee, talkee, but the Americans very much 
doee, doee." We have no desire to depart from this 
feature which has characterized our profession, and lest 
our address might to some seem to breathe a different 
spirit, we remark that the subject was chosen chiefly 
because we are met in time of war and it seemed well to 
be reminded of the higher form of patriotism as it calls 
us to better service and greater usefulness in these days 
when there is need of quickening and intensifying of 
loyalty in our civic and religious life. We call your 
attention to the manifestations of patriotism : ist, in time 
of war, and 2d, in times of peace. The immensity of the 
subject compels us to confine its field of operation mainly 
to our own beloved State, in which we believe it has had 
as true and noble exhibition as in any State of our Union. 
1st. In time of war, and we will consider principally the 
Revolutionary War, because its historical record is most 
complete, and the study we have been able to give 
provides more accurate data than could be obtained of 
the later wars. We shall not take the time, nor is it 
necessary in this presence, to detail the unjust methods 
of taxation and other oppressive measures which led the 
colonists to rebel against the mother country and resolve 
upon their independence, and we shall only briefly refer 
to the condition of niedical practice at that early period. 
From Dr. Stephen Wickes* ** History of Medicine," we 



200 MEDICAL SOCIETY OF NEW JERSEY. 

learn that in the early history of the colonies the regular 
practice of medicine was chiefly in the care of the clergy, 
and occasionally the schoolmaster who had made some 
study of medical literature was the physician and surgeon 
of his neighborhood. 

Beck's ** History of Medicine" says: " For several years 
previous to their leaving England, anticipating the loss 
of their situations as clergymen, many of them turned 
their attention to the study of medicine, and for upwards 
of a century after the settlement of New England, mem- 
bers of the native clergy were continually educated to 
both professions.** New Jersey had for years prior to and 
at the time of the Revolutionary War, a goodly number 
of these and also several educated physicians who were not 
clergymen, and some of these were distinguished by their 
knowledge in medicine, as is evidenced by their standing 
in their communities and their writings on medical 
subjects. But the quacks evidently abounded in the 
colonies. New Jersey having her full share of them, of 
whom, according to Kalm, in his travels, 1748, and 
Winterbottom, in his ** History of America,'* 1796, 
women constituted the greater number. Winterbottom 
says: "It is remarkable that in Cape May County no 
regular physician has ever found support : medicine has 
been administered by women except in extraordinary 
cases." That was published in his history thirty years 
after this Society was organized. Smith, in his *' History 
of New-York," says: "Few physicians amongst us are 
eminent for their skill. Quacks abound like the locusts 
of Egypt and too many have recommended themselves 
to a full practice and profitable subsistence. This is the 
less to be wondered at as the profession is under no kind 
of regulation. * * Any man at his pleasure sets up 
for physician, apothecary or chirurgeon. No candidates 



APPENDIX TO THE MINUTES. 201 

are either examined or licensed or even sworn to fair 
practice." Unquestionably the advance in medicine and 
the development of a strong sentiment of patriotism 
dated from the French and English War, 1758-66. New 
Jersey raised a complement of 1,000 men, built barracks 
at Burlington, Trenton, New Brunswick, Amboy and 
Elizabethtown for the accommodation of 300 men each. 
Gordon says the complement was maintained for the 
years 1758-60, and in the two succeeding years furnished 
600, besides men and officers for garrison duty, and by 
these measures incurred an average expense of 40,000 
pounds per annum. That these popular measures fur- 
nished the school much needed for training a soldiery to 
be available for the defense of American liberty a decade 
afterwards and for the training of medical men no less. 
The physicians who were commissioned as surgeons and 
surgeon's mates being brought into association with 
British officers were stimulated to improve their oppor- 
tunities of practice and intercourse with them. Toner 
says : *' The English army was accompanied by a highly 
respectable medical staff, most of whom landed in the 
city of New York and continued for some years in the 
neighboring territory, affording to many young Americans 
opportunity of attending hospitals and receiving profes- 
sional instruction." We need here to recall the fact that 
while four colleges had been formed — Harvard in 1640, 
Yale in 1701, Princeton in 1746, and King's College in 
1754, and afterwards Queens, now Rutgers, in 1770 — and 
they had graduated many men who became distinguished 
in general literature and in public life, that there was no 
medical college in the country. The College of Philadel- 
phia elected two professors in 1765, one on the theory 
and practice of medicine, and the other on anatomy and 
surgery, and three others were added in 1767. In the 



202 MEDICAL SOCIETY OF NEW JERSEY. 

latter year King's College, New York, also founded a 
medical school which was nnore complete. And it was 
in the year between these two, 1766, that this Medical 
Society of New Jersey was organized, with the three- 
fold object stated in the original call, ** for their mutual 
improvement, the advancement of the profession and 
promotion of the public good." The Society has ever 
been true in its efforts to accomplish these objects. The 
growing spirit of patriotism made it apparent that the 
promotion of the public good in securing freedom from 
the foreign yoke of oppression was the best method to 
attain all these objects in those days, and the members 
of this Society, were the leaders of public sentiment. 

When the proper time came for decisive action, New 
Jersey was ready to take her full share in the conflict, and 
none of her citizens proved their patriotism more decid- 
edly than the members of the medical profession. We are 
met tonight within the bounds of the county where the 
spirit of patriotism had one of its clearest manifestations 
and obtained one of its decisive victories. We commence 
our brief review of some of our leading medical men who 
bore conspicuous part in the war, with one of Monmouth's 
most distinguished sons — Dr. Nathaniel Scudder, son of 
Col. Jacob Scudder, of Freehold. He was one of the 
originators of our Society, and in 1770 its fourth presi- 
dent. He was one of the earliest and ablest champions of 
the patriot cause in the State, the leading spirit of the 
first meeting in New Jersey, held June 6, 1774, to take 
a stand against British tyranny ; was one of the com- 
mittee appointed to cooperate with other towns in 
carrying out measures for " the weal and safety of 
North America and her loyal sons," and he was one of the 
most active workers in those early efforts. He was a 
delegate to the Provincial Congress from New Jersey 



APPENDIX TO THE MINUTES. ^203 

in 1774, and to the Continental Congress, 1777-791 and 
one of the signers of the Articles of Confederation. At 
the outbreak of the war he was connmissioned Lieut. Col. 
of the First Regiment, and its Colonel in November, 1776. 
He was unintentionally killed by a shot from the enemy 
aimed at Gen. David Forman, with whom he was con- 
versing, Oct. 16, 1 78 1. He was for many years an Elder 
in the old Tennent Church. 

Of the other members of our profession and their 
relations to this Society who served their country, we 
make brief reference : Dr. William Adams, an original 
member of our Society, served in a Pennsylvania Regi- 
ment. Dr. Thomas Barber, our eleventh President, 1783, 
was surgeon First Regiment, State troops. Dr. John 
Beatty, our tenth President, 1782, Colonel 1776; captured 
while defending Fort Washington ; Commissary-General 
of prisoners, 1778-80; elected member of each branch of 
the legislature at different times ; speaker of the House ; 
member of the convention which adopted the Federal 
Constitution; elected to Congress 1793; elected Secretary 
of State by the legislature, 1795, serving ten years; was 
ruling elder in Presbyterian church, Princeton, for many 
years. Dr. Moses Bloomfield, an original member and 
thirteenth President of Society, 1785 ; surgeon U. S. 
hospital, became senior surgeon ; elder Presbyterian 
church, Woodbridge. Dr. William Burnett, an original 
member, second President, 1767; fourteenth President, 
1786; relinquished a lucrative practice on the breaking 
out of hostilities; exercised commanding influence as 
chairman of Committee of Safety ; on one occasion organ- 
ized and dispatched to New York a force of 300 men ; 
commissioner for issuing State bills of credit ; surgeon 
Second Regiment, Essex ; Physician-General of Hospitals, 
Eastern District, 1781 ; Judge of Common Pleas; elder 
Presbyterian church, Newark, 23 years. 



204 MEDICAL SOCIETY OF NEW JERSEY. 

Dr. John Clark was only nineteen years of age when 
the war commenced ; he enlisted as a private soldier. 
Dr. John Cochran, an original member and third Presi- 
dent, 1769; was driven from New Brunswick when hos- 
tilities commenced and his house was burned ; surgeon in 
hospital department; Gen. Washington, knowing and 
appreciating his ability, recommended him to Congress 
as Surgeon-General of the Middle Department; in 1781 
commissioned Director-General of the hospitals of the 
U. S.; after the war, President Washington retaining, to 
use his words. '*a cheerful recollection of his past 
services," appointed him Commissioner of Loans for 
the State of New York. Dr. John Condit, surgeon; 
member of legislature; member of Congress, serving 
thirty years; assistant Collector of the Port of New 
York in Jersey City. Rev. John Darby, M.D., during 
the war was one of the stirring Presbyterian " rebel 
parsons " of the time, and had an excellent reputation 
as physician and medical instructor. Dr. Samuel Dick, 
a member of our society ; served in Provincial Congress, 
1766; member of committee to draft the Constitution of 
the State; Colonel of Western Battalion, 1776; in 1780 
Gov. Livingston appointed him Surrogate of Salem 
County and he served twenty-two years; member of 
Congress, 1783-85; nominated again, but declined. Dr. 
Lewis Dunham, nineteenth President, 1791, and thirtieth 
President, 18 16; surgeon. Dr. Ebenezer Elmer, a mem- 
ber; in 1776, ensign, then lieutenant under Gov. Bloom- 
field; 1778, surgeon's mate; surgeon Second New Jersey 
Regiment, serving till close of the war; 1800, member of 
Congress, serving six years; Adjutant-General of militia 
many years; 1808, Collector of Port of Bridgeton, serv- 
ing fifteen years. 

Dr. Jonathan Elmer, fifteenth President of our Society, 



APPENDIX TO THE MINUTES. 205 

1787 ; active on outbreak of hostilities; member of Com- 
mittee of Vigilance and rendered great service to the 
cause as sheriff ; delegate to the Provincial Congress ; 
member of legislature ; member of Continental and 
National Congress; served in U. S. Senate; Presiding 
Judge Court of Common Pleas many years; ruling elder 
in Presbyterian Church, Bridgeton. Dr. John F. Grandin 
was a surgeon in the navy and served throughout the war. 
Rev. Jacob Green, M.D., a Presbyterian pastor as well as 
physician, who practiced with much success for thirty 
years ; during the war was an earnest patriot, known as 
one of the " rebel Presbyterian parsons"; member of the 
Provincial Congress and chairman of the committee 
which drafted the first Constitution of the State ; one of 
the first trustees of the College of New Jersey, its Vice- 
President, and for six months discharged* the duties of 
President ; was the father of Rev, Dr. Ashbel Green, 
President of that College. 

Dr. Thomas Henderson, elected member at second meet- 
ing of Society, 1766; member of the Provincial Congress ; 
Colonel of State troops; member of Congress; acting 
Governor of State in 1794, during Gov. Howell's absence; 
Surrogate; member of Legislature; Judge of Common 
Pleas; commissioner to settle boundaries between this 
State and Pennsylvania ; during most of the time did not 
relinquish his professional calling ; ruling elder in old 
Tennent Church more than forty years. Dr. Isaac 
Harris, an original member, and twentieth President, 
1792; surgeon; civil magistrate; elder in Presbyterian 
church, Daretown, Salem County. 

Dr. Ebenezer Howell took an active and prominent 
part in the war and was threatened by the enemy ; major ; 
entrusted by Gen. Washington with convoy of ammuni- 
tion, 1776, and received his thanks in an autograph letter. 



206 MEDICAL SOCIETY OF NEW JERSEY, 

Dr. William £. Imlay, a member; captain; received a 
letter of commendation from Gov. Livingston. Dr.. 
Jonathan F. Morris; at the age of sixteen he entered the 
service, 1776, as Ensign; Lieut, in 1777; surgeon, 1781, 
having studied medicine with Drs. Scott and Shippen,. 
1778-81. Dr. James Newell, our sixth President, 1772; 
surgeon Second Regiment. Dr. Bodo Otto entered the 
army as surgeon, 64 years of age, when about retiring 
from practice ; in charge of hospital at Valley Forge 
during the memorable winter of 1778. Dr. Bodo Otto, 
Jr , surgeon ; member of Upper House of Legislature ; 
Col. of State troops. Dr. Frederick Otto, surgeon in 
hospital. (The above, father and two sons.) 

Dr. Robert Patterson, surgeon's mate ; Brigade Major ; 
Prof, of Mathematics in University of Pennsylvania; 
appointed director of U. S. mint, 1805; elder Scotch 
Presbyterian Church, Philadelphia. Dr. Matthias Pierson^ 
a member ; was emphatic in declaration of his patriotic 
sentiments, and industrious in efforts to inspire others ; 
identified in all educational and other efforts for the 
public good. His son, Dr. Isaac, was a member of our 
Society; Sheriff of Essex County and member of 
twentieth and twenty-first Congresses. 

Dr. John B. Riker became a member in 1768; was an 
earnest patriot who incurred the special enmity of the 
enemy ; enlisted as a surgeon. Dr. John Ross, a mem- 
ber; Captain of Third Regiment, 1776; Major Second 
Regiment; Brigade Major; appointed in 1792, Inspector 
of Revenue for Burlington County. Dr. Henry H. 
Schenck, a member ; surgeon of militia ; Judge of Common 
Pleas ; elder of Reformed Dutch Church, Millstone, for 
several years. Dr. Moses Scott, seventeenth President, 
1789; had served when 17 years of age, under Braddock,. 
and was a commissioned officer when Fort du Quesne 



APPENDIX TO THE MINUTES. 20/ 

was captured. He was appointed surgeon, Second Regi- 
ment, Middlesex; surgeon in general hospital; 1777, 
senior physician and surgeon of the hospitals and assist- 
ant Director General; at Princeton he was near Gen. 
Mercer when he fell. (The General was also a distin- 
guished physician.) Dr. Scott was for thirty years a 
ruling elder in the First Presbyterian Church, New Bruns- 
wick, and for many years treasurer of its Board of Trus- 
tees. Dr. John Anderson Scudder, son of Dr. Nathaniel, 
before referred to. He was a member of its Society ; 
surgeon's mate, 1777; for several years member of 
Assembly; member of Congress 18 10. 

Dr. Isaac Smith, fifth President of the Society, 1771 ; 
Colonel First Regiment, Hunterdon ; Justice of the N. J. 
Supreme Court 1777, serving seventeen years; member of 
Congress; Presidential elector 1801. Dr. Benjamin B. 
Stockton, member in 1781; surgeon's mate; surgeon; 
junior surgeon of hospital department. Dr. Ebenezer 
Stockton, a member; surgeons mate; afterwards on 
recommendation of Dr. Benjamin Rush he was appointed 
surgeon in a New Hampshire regiment. Dr. James Strat- 
ton, sixteenth President of Society, 1788 ; he espoused the 
patriot cause and gave his services to his country ; Judge of 
Court of Common Pleas ; active in Protestant Episcopal 
church. Dr. Peter I. Stryker, twenty-third President, 1808, 
thirty-first President, 18 17, and thirty-eighth President, 
1824. During the war, though only 13 years of age, 
"he assisted in furnishing supplies to the American 
troops stationed near his home, particularly the brigade 
of Gen. Wayne "; was sheriff ; State Senator and Presi- 
dent of the Senate several years ; was acting Governor 
for a short time ; senior Major General of militia more 
than thirty years. For 19 years an earnest member of 
the Reformed Dutch Church, the record says, ** rarely 



208 MEDICAL SOCIETY OF NEW JERSEY. 

ever absent from the Sacrament of the Lord's Supper." 
Dr. Garret W. Tunison, volunteered as a private soldier ; 
surgeon's mate; surgeon of an artillerj^ regiment; served 
till the army was disbanded in 1783; member of the Legis- 
lature. In addition to the above there were the following 
34 commissioned surgeons who served during the war: 
Dr. John Andrews, J. Avert, Cornelius Baldwin, Oliver 
Barnet, William M. Barnet, William Burnet, Jr., Bernar- 
dus Budd, George W. Campbell, Jabez Campfield, John 
Cowell. Gershom Craven, Robert Cummins, David Ervin, 
James English (my grandfather), Thomas Ewing, Melanc- 
thon Freeman, Jacob Harris, John Hampton, Thomas 
Hendry, James Holmes, Jonathan Horton, Lewis Howell, 
Jacob Jenning (Rev.), Uzal Johnson, Timothy Johnes, 
Charles McCarter, David Pearson, Thomas Reed, Nicho- 
las Roach, Samuel Vickars, Abram Van Buskirk, 
William Winants, Lewis Wilson, John Witherspoon. 
Also the following additional commissioned surgeon's 
mates: Abraham Appleton, Stephen Ball, John Darcy, 
Moses G. Elmer, Robert R. Henry, Ephraim Loring, 
John Hammell. 

It is evident that not many members of the Medical 
Society of New Jersey, during the Revolutionary War, 
could have remained at home. Its membership in Nov- 
ember, 1775, could hardly have exceeded three score in 
number, and we have given a list of eighty medical men 
who served, and the records of the Society for May 7, 
1782, tell us why this Society held no annual meetings 
for the six years from November, 1775 to November, 
1 78 1, in these words: **The war (which has been produc- 
tive of the happy revolution in America) having claimed 
the attention of all ranks of Freemen, most of the mem- 
bers of this Society took an early, decided part in the 
opposition to British tyranny and oppression, and were 



APPENDIX TO THE MINUTES. 209 

soon engaged either in the civil or military duties of the 
State,'* etc. With a very few exceptions they were 
earnest patriots. After careful search we believe that 
only five members of the Society adhered to the ** loyalist " 
or British side, three of whom were clergymen as well as 
physicians, and they all either entered the British service as 
surgeons, or finding the climate too warm, sought other 
localities safer and more congenial. We believe that an 
equal proportion of the regularly educated medical prac- 
titioners who were not connected with this Society, were 
patriots. It is very interesting to note that these were men 
of culture and of decided influence in their communities. 

Dr. Wickes, in his " History of Medicine and Medical 
Men in New Jersey," says: ** It is worthy of note also 
that the majority, and certainly the most influential of 
them, were men of decided religious character, members 
and ofHcers in the Church of Christ.** We find that 
four of them were clergymen with charges as well as 
medical practioners of ability, and one of them had a 
reputation as a medical instructor, pupils seeking his 
instruction from distant places. Ten of them were 
Presbyterian ruling elders, two elders in the Reformed 
Dutch Church, one a vestryman in the Protestant Episco- 
pal Church, of whom the record says: ** He assembled his 
family on Sunday afternoons to instruct them in the West- 
minster catechism." No wonder there were sturdy patriots 
in those days. The Presbyterians arc this year celebrat- 
ing the 250th anniversary of the completion of the 
Westminster Standards, which were the outcome of over 
half a century's struggle for civil and religious liberty. 

But we note again, that these patriots not only fought 
the battles and gained the victories, and secured our 
independence, but they were wise enough and true-hearted 
and virtuous enough to see that victories won and inde- 



2IO MEDICAL SOCIETY OF NEW JERSEY. 

pendence gained, amounted to little unless the founda- 
tions of the government were laid strong and secure, and 
that patriots who were true to God, to liberty and 
righteousness were placed in power to build enduringly. 
We have observed that these patriotic physicians not 
only fought well and performed their high and holy 
mission faithfully but they served as well and as accep- 
tably in official positions. Six served in the Provincial 
Congress, five in the Continental Congress, eleven in the 
National Congress, six in the Provincial Assembly, eight 
in the State Legislature, five as sheriff, four as surrogates, 
ten as judges, and others in various other capacities 
which we will not take the time to specify. (Five out of 
the 56 signers of the Declaration of Independence were 
members of our profession, or 9 per cent.) These were 
incorruptible office holders; they were upright judges; 
they were politicians in the highest sense, who loved 
country more than party ; they used no corruption fund 
and the people were not of that kind that sold their 
birthright for a mess of pottage. 

Just one illustration: Dr. Jonathan Elmer, a name 
honored in this Society, was United States Senator from 
New Jersey. Senator Maclay, an associate in the Senate, 
said of him : ** I know not in the Senate a man, if I 
were to choose a friend, on whom I would cast the eye of 
confidence as soon as on this little doctor. He does not 
always vote right — and so I think of every man who 
differs from me — but I never saw him give a vote but 
I thought I could observe his disinterestedness in his 
countenance. If such a one errs it is the sin of ignorance, 
and I think heaven has pardons sealed for every one of 
them." While it has been impossible to secure accurate 
data concerning the number and names of members of 
our profession who served in the other wars in which our 



APPENDIX TO THE MINUTES. 211 

-country has been engaged, we have the following as the 
number serving in the late Civil War, although we do 
not believe it comprises them all : In the volunteer 
service 13 brigade surgeons, 55 regimental surgeons, 85 
assistant regimental surgeons and i colonel. In the 
regular army : I surgeon and I assistant sugeon. In the 
navy: i surgeon, 14 assistant surgeons and 2 acting assist- 
ant surgeons.* 

Besides these there was a large number, including 
many of the ablest surgeons in the State, who volunteered 
for brief terms of emergent service! in hospitals and on 
the battlefields after some of the fierce and destructive 
engagements of the war. An eminent physician, in rep- 
resenting a sister State Society at our annual meeting in 
1874, said: "It was my privilege in the war, in the 
responsible position in which I was placed, to have New 
Jersey surgeons. I found them men on whom I could 
rely in all emergencies, and I relied on them, and be 
assured, gentlemen, that they honored you as much in 
their art as your soldiers honored your State on the 
battlefield/' 

The record of the past will be the record in the present 
war with Spain, not only in the prompt response of our 
physicians to the call, but also in the value of the service 
rendered and in the heroism displayed. The first to give 
his life on Cuban soil was Dr. John Blair Gibbs, whom 
-we had the honor to know, for he was a resident of New 
Brunswick in former years and was educated at Rutgers 
College. Heroically doing his duty, he fell a martyr in 
the cause of humanity. A worthy son of noble patriotic 
sires; his grandfather a hero in the Revolutionary War and 



•Since the above was presented a letter from Adjutant General W. S. Stryker 
informs me that the total number of our sugeons in the War of the Rebellion, 
1861-65, was surgeons 63, assistant surgeons 134. 



\ 



212 MEDICAL SOCIETY OF NEW JERSEY. 

his father in the War of the Rebellion. The patriotism 
that leads the physician to forsake his practice and go amid 
the dangers of the battlefield, exposed to the deadly 
miasm of the swamp or the deadlier shower of grape» 
canister and shell, to care for the sick and wounded, is 
worthy of all praise and receives it, and all true and loyal 
hearts, as we do tonight, cherish and revere their names 
and the noble records they made, and will preserve these 
records and rehearse them, that coming generations may 
know of them and honor their memory. But let us not 
forget that the services of those who remained at home 
in the no less faithful discharge of duty in providing for 
the soldiers at the front and their families, and sustain- 
ing the government and thus promoting the public good, 
showed no lack of patriotism. At the outbreak of our 
Civil War the father of a small family felt that he could 
not stay at home while his neighbors went to the war. The 
boys agreed to take care of the place and help mother, 
while the father fought for the flag. Each did his part 
well. The boys' farming elicited the warm praise of a 
passing gentleman, to whom one of them said : " Father's 
fighting, Tm digging and mother's praying." " Fighting, 
digging, praying ! *' exclaimed the gentleman, *' that's the 
patriotism that will bring our country out of her distress." 

The physician's service in the camp, in hospital, on the 
the battlefield, was but for a few short months or years, 
while his service and that of his brother physician serv- 
ing at home in the great battle with disease, is life-long. 
This brings us to the consideration of the second part of 
our subject : Patriotism as manifested by our profession 
in times of peace. 

We state without extended argument, because in this 
presence it is not needed, that here is its highest, noblest 
manifestation, so vastly more important as peace is pre- 



APPENDIX TO THE MINUTES. 213 

ferable to war. The public good is the very purpose for 
which government exists, and when it no longer secures 
the highest protection and interests of its citizens, it 
should be overthrown and some other form should take 
its place, by the will of the people expressed by the ballot 
or by revolution. We need to have our memories re- 
freshed by an occasional reading of the Declaration of 
Independence and the Constitution of the United States 
— the coming Fourth of July will be a most fitting occa- 
sion for reading and meditating upon them. 

This form of patriotism not only has its highest and 
noblest exhibition in times of peace, but it has its con- 
tinuous, life-long display, often amid struggle and self- 
denial, and not infrequently in self-sacrifice. Our profes- 
sion stands sponsor for very much that is intimately 
associated with human progress, happiness and well being. 
We boldly affirm that the prosperity of the State and its 
citizens is more affected by the scientific attainments, 
character and work of the medical profession, than by 
any other class of its citizens. When they are actuated 
by a spirit of unselfish devotion to the public good, it 
means the constant advance of all that contributes to the 
material, moral and intellectual as well as physical 
well-being of the State and the people, to the largest in- 
crease of its population and wealth, and to its standing 
and glory in the sisterhood of states. The self-seeking, 
greed-of-gain, non-ethical spirit is not only inconsistent 
with and inimical to true patriotism, but is unworthy of 
recognition by the true physician and brings dishonor to 
the profession when exhibited. As we have observed, 
the last of the three objects for which our Society was 
organized was ** the promotion of the public good ;" but 
it was by no means the least because mentioned last, for 
had this object been omitted or unsought, then *' mutual 

14 



214 MEDICAL SOCIETY OF NEW JERSEY. 

improvement " and " the advancement of the medical 
profession " had been for purely selfish interest, a motive 
utterly unworthy a noble profession and devoid of all the 
elements of patriotism, for the public good is the animat- 
ing principle, the life and soul of patriotism. War, if it is 
not waged in the interest of humanity, or for the highest 
good of the people who engage in it, is iniquitous ; no 
law of God justifies it, no vox populi can make it right 
and no lasting good can come from its prosecution. 

The promotion of the public good, we assert, was the 
great aim of the originators of this Society when they 
sought, as it must ever be with the worthy member of 
the medical profession at large, when he seeks through 
organizations, '^ mutual improvement '' and the advance 
of the profession. We have no hesitation in retrospect- 
ing our past record. We are proud of our Society and 
of the profession's record in the relief of human suffer- 
ing, in the prolongation of human life and in the 
improvement of the environments of that life, which 
makes it happier, purer and better, and enables it to 
.fulfill its aim and end. We believe the facts justify our 
•claim that the medical profession, when true to itself and 
iits heaven-born origin, has manifested and is constantly 
•displaying more true patriotism than any other body of 
:men, and are assured that it is not poetic fancy, but solid 
:Statement of veritable truth that •* Peace has her victor- 
ies no less renowned than war." We will consider briefly 
•some of the many directions in which this patriotism has 
found, and is finding, expression. 

I. We observe that there is much of heroism in the 
regular practitioner's work, as he comes in contact with 
contagious diseases in their deadliest forms. But it is said, 
practice brings a pecuniary reward. We reply, not 
always, rarely adequate and never when the physician or 



APPENDIX TO THE MINUTES. 21$ 

his loved child, to whom he has brought contagion, is 
sacrificed through his devotion to the sick ; and again we 
remark that there is also some pecuniary reward for the 
patriotic soldier. When we consider the work of scien- 
tific observation and research, we must remember that it 
involves pecuniary sacrifice and sometimes the sacrifice 
of life. When the plague was making a desert of the 
City of Marseilles, death was everywhere. The physic- 

4 

ians could do little. In one of their councils it was 
decided that a corpse must be dissected, though it would 
be death to the operator. The celebrated physician, 
Guyon, arose and said : ** I devote myself for the sake of 
my country. Before this numerous assembly, I swear, 
in the name of humanity and religion, that tomorrow, 
at the break of day, I will dissect a corpse and write 
down, as I proceed, what I observe." At daybreak, the 
following morning, he fulfilled his vow, recording his 
observations, taking precautions so to disinfect the paper 
on which they were written that it would not convey 
the disease, and Guyon died about twelve hours after 
completing the work. 

Illustrations might be multiplied of life, strength or 
possessions sacrificed, but much oftener still these 
devoted men receive reproach and opposition, as, for 
example, from the sickly sentimentalists and cranks who, 
in their devotion to a few dumb animals, are willing that 
multitudes of human beings shall suffer and die. We 
should not fail to recognize the magnitude of the work, 
as our science h^s been thus compelled to grope and 
fight her- way amid the ignorance, superstition and 
cupidity which have hindered and opposed her marvel- 
ously progressive course. We do not wish to make 
invidious distinctions between this and the other two 
learned professions when we speak of the one great 



2l6 MEDICAL SOCIETY OF NEW JERSEY. 

difficulty the medical scientist has to contend with^ 
which they have not. The lawyer has his one great text- 
book, connpiled by the greatest of law-givers — the 
inspired Moses — and all subsequent laws for the public 
good have been founded upon and have their great 
principles enunciated in that one great text-book. The 
clergyman has his one text-book — the bible — which con- 
tains all that is needful, for all time, of religious truth 
for securing and maintaining spiritual health, and all 
attempts to construct a new bible have met and will 
meet with failure. It is the infallible word of God,, 
the author of all science. These sciences of law and 
religion are fixed, exact sciences. There is no progress 
in them, though there ever is progress in the art which 
applies them. On the other hand, the medical prac- 
titioner has no infallible text-book ; the science as well 
as the art is ever progressive. The text-book, so-called, o£ 
yesterday is discarded today, because the unfolding of 
medical science is making such rapid progress. The 
careful, conservative practitioner must therefore not be 
blamed if he refuses to jump at conclusions, and insists 
on weighing half-knowledge statements of enthusiasts,, 
and awaits fuller revelations. It is well for us all to 
realize the fact, and remember it, that to us in this gen- 
eration, as it will doubtless be to some generations 
following, there is no finality in medicine, and not till 
the last discovery is made and the last word spoken, are 
we likely to have a perfected science. Well may we ask,, 
is there any loftier patriotism than that which is actively 
engaged in the search after that perfection, and which, 
means greater blessing to humanity ? 

2. In the Work of our State Medical Society,. 

which has been purely in the interest of the public, and 
in most cases against the pecuniary interests of the pro- 



APPENDIX TO THE MINUTES. 2X7 

fession. As we were honored with your attention three 
years ago in presenting this work at length from another 
point of view, we shall merely cite a partial list of what 
the Society has sought, and in most cases accomplished, 
to the honor of the State and the blessings of its 
citizens: (i) The securing, after several years* effort 
before the legislature, the State Hospital for the Insane, 
at Trenton ; afterwards its enlargement ; then the second 
State Hospital, at Morris Plains, and subsequently, the 
improvement of the condition of the insane in the 
county almshouses. (2) Securing of an Act from the 
legislature, creating a Committee of State Charities and 
Correction. (3) Securing an Act creating the State 
Board of Health, after twenty-five years of persistent 
effort. (4) Efforts to secure a pure milk supply. (5) 
Securing laws for the suppression of criminal abortion. 
(6) Efforts for the prevention of blindness in young 
children. (7) Efforts to control and exterminate bovine 
tuberculosis. (8) Efforts for reform in methods of 
securing expert medical testimony. (9) Efforts to 
secure more competent dispensers of medicine, resulting 
finally in the incorporation of the New Jersey Pharma- 
ceutical Association. (10) Efforts for the prevention of 
purulent conjunctivitis in the new-born, (i i) Efforts for 
the founding of an Epileptic Colony in our State, which 
we were remarkably successful in securing this year, 
without the usual delay on the part of our legislators, 
besides the many efforts for the improvement of school 
buildings and of the health and healthful teaching of 
the children in our schools, to which reference will be 
made. 

3. In THE Cause of Education.— With satisfaction 
and pride we remind you of our Society's continuous 
effort for higher medical education. In insisting upon 



2l8 MEDICAL SOCIETY OF NEW JERSEY. 

advance in the preliminary requirements for entering 
upon and thoroughness in the study of medicine, with 
extended time, and fuller, more scientific and practical 
curriculum, and greater care concerning the examination 
for graduation and licensure to practice, as well as in the 
construction of a perfect code of ethics, our efforts have 
been infinitely more for the public good than for any 
benefit that might come to the individual practitioner. 
The scientific attainments and the practical application 
of the art by the physician of today, the general prac- 
titioner — even the village doctor, is far in advance of the 
preceding generation. We use the word " even," in 
reference to the village doctor, in no invidious sense, for 
we realize that he is not ignorant of the progress in 
medicine, though his incessant work may give him less 
opportunity for study. The more thorough teaching 
of state medicine and hygiene in the regular medical 
colleges is an important advance, as was the first step 
taken in this country to establish the post-graduate 
degree of Doctor Medicinae Civitatis, by Rush Medical 
College, Chicago, in 1895, which was designed to provide 
thoroughly qualified health officers for our cities. We 
regret exceedingly that it was discontinued last year 
because of the lack of applications, but the dean of the 
college informs me that it may be renewed again, as the 
demand for more thorough qualification is increasing. 

In the cause of general education, the profession has 
exerted an exceedingly helpful influence. Our fore- 
fathers, we saw, laid the foundations of our government 
well and strong, not for temporary, but permanent 
growth and prosperity, and they were not ignorant or 
careless as to the important part education occupied in 
giving solidity and strength. Most of the members 
were college graduates; two were college presidents. 



APPENDIX TO THE MINUTES. 219 

three professors, six college trustees — three each in 
Princeton and Queens, now Rutgers. Our Society, 
today, has honored trustees in both colleges mentioned, 
and many are serving on boards of education, all gratuit- 
ously. It is with great satisfaction we note the move- 
ment inaugurated by Rutgers College, for the improve- 
ment of the qualifications of sanitary inspectors, etc. 
The college appointed early in the past year, a Board of 
Examiners, consisting of Prof. C. F. Brackett, M.D., 
LL.D., of Princeton University, William K. Newton, 
M.D., and John L. Leal, M.D. (who are members of 
this Society), Judge William M. Lanning, Prof. F. C. 
Van Dyke, Ph.D. and Prof. Edw. B. Voorhees, the two 
latter of Rutgers College. These will conduct examin- 
ations and grant certificates in municipal hygiene to 
officers of local boards of health, sanitary inspectors, 
factory inspectors, plumbing inspectors and to those who 
may seek appointment to these positions. Three certifi- 
cates have already been given during this past month. 
This is the first college to introduce this advanced move- 
ment, which gives promise of improved health adminis- 
tration in our cities, and we hope other colleges will 
follow Rutgers' example. 

The profession has not been indifferent to the fact that 
our educational institutions constitute a strong bulwark 
of national defense and are a potent factor in moulding 
national character. The physician, today, 'as he gives 
thought concerning the 400,000 teachers and 14,000,000 
school children, must do his share in securing the best 
care, instruction and development of these millions, 
through healthful methods of education, amid healthful 
environments. Much has been done in the way of 
improvement, especially in emphasizing and impressing 
the paramount importance of considering the relation of 
mind and body, and so adjusting methods that they 



220 MEDICAL SOCIETY OF NEW JERSEY. 

be systematically trained, growing together in strength 
and power, forcing neither at the expense of the other. 
Mens Sana in corpare sano must continue to be our 
demand. Prof. J. M. Green, Ph.D., principal of our 
State Schools, writes me : '* We give credit to the medical 
profession for our laws respecting vaccination, for our 
measures for the prevention of the spread of contagious 
diseases, for our physical training in the schools and our 
provisions for sanitation and ventilation. We are doing 
all we can to successfully carry out these measures in our 
practice, and incorporate them in the education of our 
youth.*' That we have not yet obtained perfection 
in our public school system is very forcibly impressed 
in Dr. E. Stuver's address before the American Medical 
Association last year, and published in "The Journal," 
December i8, 1897. In it is .shown the fact that our 
leading educators are far from unity in approval of 
all the present methods of teaching. 

Great advance has been made by introducing the study 
of physiology and personal hygiene in our schools. In 
addition to the practical teaching of these branches, we 
believe the children should be taught the essential facts 
concerning the manner in which contagious diseases 
spread, and the methods of prevention ; especially why 
disinfection and isolation are required, and that their 
minds should be impressed through the eye, by the use 
of diagrams, that sanitary measures are effective. We 
believe that a judicious system of study covering these 
points should be carefully elaborated by the joint action 
of our State Board of Health and State Board of Edu- 
cation, and be introduced into our schools.* 



* Since writing the above, we have learned from the Secretary of State of 
Michigan, that the legislature of that State, in 1897, made an appropriation of 
$2,500 under "An Act to provide for teaching in the public schools, the methods 
by which dangerous and communicable diseases are spread, and the best methods 
tor the restriction and prevention of such diseases." 



APPENDIX TO THE MINUTES. 221 

4. In the Cause of State Medicine. — Preventive 
medicine is the crowning blessing the medical profession 
has conferred on humanity, and is the embodiment of 
the highest type of patriotism the world has ever wit- 
nessed, for it is virtually in the final attainment of the 
aim and end sought, the profession sacrificing itself. The 
Nestor of American surgery, Prof. S. D. Gross, M.D., 
LL.D., said twenty years ago : ** The great question of 
the day is not this operation or that, not ovariotomy, or 
lithotomy, or hip-joint amputation, which has reflected 
so much glory on American medicine, but preventive 
medicines," etc., etc. The patriotism that finds its 
expression in the times of war is destructive of life and 
treasure, and fills the land with sorrow unutterable. The 
work of rescuing life from the attacks of disease, and 
preserving treasure, is vastly more beneficent and wipes 
away the tears of sorrow; but this greatest of all 
exhibitions of patriotism that saves even from disease 
and all its attendant misfortunes, anxieties and losses, 
has made the profession worthy of the undying gratitude 
-of humanity. It has done more than all else to magnify 
the lofty position and dignity of the true physician and 
jnade him a worthy follower of the Great Physician, 
who, in the loftiest manifestation of usefulness the 
-world has ever seen, ever "went about doing good." 
The final question he propounds is that of the Master, 
"* Wilt thou be made whole ? " 

An ancient writer called the physician, " Manus Dei." 
Surely, this department of the physician's activities 
-shows a recognition of his responsibility as God's agent. 
The conscientious physician, under a full sense of that 
responsibility, will have an abiding faith in Him, without 
whose aid he is powerless. We can give but a very 
trief presentation of the profession's work in this great 



222 MEDICAL SOCIETY OF NEW JERSEY. 

department, for it is a vast subject. We recognize the 
fact that Moses, the great law-giver, gave the world the first 
great work on preventive medicine, and doubtless, if past 
generations had faithfully followed his inspired teachings,, 
the world would have been saved most of the terrible 
plagues that have scourged it, and sanitarians would have 
been saved most of their work today. But human per- 
versity has compelled humanity to pay the penalty of 
gross Willfulness, ignorance and carelessness. Examples- 
of extensive sanitary works for the improvement of 
health might be given, e. g. in ancient times, such as 
Rome's enormous aqueducts, particularly those built by 
Agrippa, which were virtually rivers brought into the 
city to flush streets and sewers, and in later times the 
great plagues of the world have been greatly mitigated 
in severity and lessened in frequency through sanitary 
measures. But it remained for the middle of the present 
century to give us the science of State medicine as it is 
now understood. The eminent English sanitarian, 
Chadwick, showed that a norma of sanitation for the 
infantile stages of life may be established with factors^ 
that leads to the prevention of an annual excess of 
upwards of 50,000 deaths in the school stages of life \n 
England and Wales, and gave his experience in two large 
institutions with Dr. Arnott, the sanitary specialist,, 
pointing out the causes and remedies for the terrible 
death-rates. 

The work in the United States really commenced in 
Massachusetts and New Jersey in 1849, «tlthough an 
initial step was taken by this Society for securing accu- 
rate registration of deaths and their causes, in 1847. ^^^ 
Massachusetts could not secure its board of health untii 
1869, and, as we have seen, it took this Society over 26 
years of presistent effort to secure from our Legislature a. 



APPENDIX TO THE MINUTES. 223 

law creating our State Board, which was finally organized 
in 1877. Five of the seven members appointed were 
members of the Medical Society of New Jersey, and the 
same proportion of its members has been continued. 
The president and secretary have also been members of 
this Society as follows ; Presidents, Elias J. Marsh, Sr., 
M.D., 1877-78; T. R. Varick, M.D., 1879; C. F. Brackett^ 
M.D„ LL. D., 1880 to date. Secretaries, Ezra M. Hunt^ 
M.D. LL.D., from 1877 till his death July, 1894; Henry 
Mitchell, M.D., from July, 1894 to date. Able laymen 
have been associated with these and other prominent 
physicians and rendered most valuable service. 

Wonderful results have been achieved in the brief 
period of its history. It is well to remember that the 
greatest advances in the science of medicine have come 
within the period of activity in this department, and 
many of the discoveries have come in connection with 
the prosecution of its work. We need not, in this pre- 
sence, enter into any description of the methods or 
character of the great work that has been done through- 
out the country, or even in this State. We do ask that 
you will, at your leisure, give careful attention to and study 
of, the last report of our State Board of Health,which shows 
some of the excellent results already accomplished. We 
have given it considerable study and only the lack of 
time at our disposal and the fear of wearying you and 
exhausting your patience, compels us to forego present- 
ing many facts of the deepest interest. We shall refer 
only to the condensed record of the ten leading diseases 
which are designated as preventable, for the past ten 
years, and what it means as an example of the greatest 
practical patriotism. 



224 



MEDICAL SOCIETY OF NEW JERSEY. 



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APPENDIX TO THE MINUTES. 22S 

The most urgent need of the public health service in New 
Jersey, as elsewhere, is better, more intelligent adminis- 
tration of our excellent code of sanitary laws. The pop- 
ular appreciation of the value of pure water, pure soil and 
pure air, has progressed far more rapidly than has the 
executive ability of the persons charged, under the laws, 
with the duty of securing or preserving these essentials 
to good health. We believe that the introduction of the 
system of medical inspection of schools and school child- 
ren, in the cities of this State especially, should be 
effected at the earliest possible date. The revelations 
made and the excellent results obtained through such in- 
spection in Boston, New York, Philadelphia and Chicago, 
have abundantly proven it to be one of the most effective 
measures for the prevention not only of the spread of 
contagious diseases, but also of the fearful increase of 
ocular diseases among children. From a letter received 
last evening from Dr. S. H. Durgin, Health Officer of 
Boston, Mass., we learn that there were in 1880, in 
Boston, 8,531 deaths, of which 2,321 were due to prevent- 
able diseases, and in 1897 there were 11,154 deaths, of 
which 1,806 were caused by said diseases, showing that 
2y.\i% in 1880 and \6,ig% in 1897 where due to prevent- 
able diseases, or a gain in 1897 ^^ nearly 1 1 out of every 
hundred deaths. 

In Newark, N. J., in 1880, there were 38.66^ in every 
hundred, and in 1897 there were 33.69^ in each hundred, 
due to preventable diseases. In Jersey City, in i88o, 
there were 42.91^ in every hundred, and in 1897 there were 
33.33^ in each hundred. While our New Jersey cities 
show a decided gain, it is small compared with Boston* 
How much is due to the thorough medical inspection 
of schools in Boston, we can conjecture from the results of 
such inspection, e. ^., in the first two years after inspec- 
tion of Boston schools was introduced, 23,207 children 



226 MEDICAL SOCIETY OF NEW JERSEY. 

were examined, of whom 16^571 were not well and 2,818 
were sick enough to be sent home. Of these latter, 5 14 
were suffering from infectious diseases as follows : Diph- 
theria 90, scarlet fever 35, measles 163, whooping-cough 
loi, mumps 65, congenital syphilis 13, chicken-pox 43, 
tuberculosis 2, influenza 2. These children were in their 
seats spreading infectious diseases amongst the other 
children. In another examination, 169 children were 
found with parasitic disease of the head. It has also 
been demonstrated in Boston, that during the past twenty 
years there have been far less number of cases of infec- 
tious diseases during the vacation periods of the schools, 
than in the school months. One able physician has 
estimated that 70^ of epidemics might be prevented by 
thorough inspection of the schools. In reference to the 
great increase of ocular troubles among school children 
from eye strain, we cite only one iliustration. In Phila- 
delphia, out of 2,000 children examined, 54^ were found 
suffering from defective vision, and it was ascertained 
that near-sightedness increased from 4^% in children 8i 
years of age to nearly 20% at 17J years of age. 

5. In Professional Charity. — Here we wish to be 
clearly understood. The physician, above all men, is 
expected to have, and ought to have, a full share of that 
sweet, heaven-born charity 'which is the chiefest of all 
the Christian graces. We here refer, however, to that 
charity which is pity and compassion for the poor in the 
relief of their sufferings in sickness ; it may or may not have 
much of the real love in it. But in both the scriptural 
and the worldly view, it can be said generally of the 
medical profession, that they have that charity which 
** suffereth long and is kind," that ** seeketh not her own," 
" beareth all things," and certainly " never faileth," to an 
exceptional extent, and that they are thus patriotically 
and religiously contributing largely to the public good. 



APPENDIX TO THE MINUTES. 22/ 

Their voluntary attendance on many indigent families, 
their services in dispensaries and hospitals, their work 
on health and educ&tional boards, and generous response 
with service and money to the many regular and emer- 
gent calls, cannot be calculated, nor do we wish to esti- 
mate it ; it is not only voluntarily but also cheerfuly 
rgiven, even sometimes when it is not appreciated. 
. There are, however, evidences that certain exhibitions 
of it are neither for the public good or that of the medi- 
<al profession. We refer to what may be justly charac- 
terized as the abuse of it, when given in dispensaries and 
hospitals to those who are able to pay ; when the physi- 
cian is compelled to give service because those who are 
paid by municipalities to attend the sick neglect their 
duty or are incompetent. The amount of medical charity 
in New York City last year was four times as much per 
•capita as it was in 1830. The number that claimed in 
one year to be unable to care for themselves and ob- 
tained free medical assistance in the dispensaries and 
•hospitals there, was equal to more than 49^ of the popu- 
lation of the city. It has been estimated that 45^ of 
applicants at the dispensaries could pay if they would, 
and that in May, of this year, there were 5,000 vacant beds 
in the hospitals of New York. 

This abuse of charity is a detriment to the patient 
wrongly helped because of its pauperizing tendency, to 
the worthy poor who should have the benefit of the 
money contributed for them, and to the public in en- 
couraging improper or unwise chanty. Let it be ever 
impressed that the truest and most wholesome charity is 
that which helps the recipient to help himself, and yet is 
diot hypercritical in dealing with the worthy poor. The 
city physician who neglects his most sacred trust, or is 
incompetent for the position which he retains only by 



228 MEDICAL SOCIETY OF NEW JERSEY. 

political influence, is untrue to the profession and un* 
worthy of membership therein. Our own belief is that it 
would be vastly better if that office were removed from 
municipal appointment and entirely free from politics, 
and that the board of health, in our cities especially, 
should have the power to appoint from one to five 
physicians, according to the population and the needs, 
and they might be the medical inspectors of the schools* 
The work of the city physician is very closely related to that 
of the health board — he is indeed generally an ex-officio 
member of the board. The efficiency of the board in the 
prevention of disease and of the arrest of epidemic out- 
breaks, would be greatly increased by their hearty coopera- 
tion. The point we wish to emphasize is that the poor shall 
not be neglected and should have the best medical skill and 
attention, though the salary has to be $i,ooo or more a 
year to provide it. Their rights, Christian charity and 
the public good demand it. 

6. In Political Life.— We have referred to the 
activity of the members of our profession in political life 
during and immediately after the Revolutionary War, 
and that that activity was ever exerted in securing and 
maintaining good government and the people's highest 
interests. Men of ability and character were elevated to 
high positions, many physicians among them, like Senator 
Elmer, who, as we saw, drew high praise from his fellow 
member of the opposite party, for there were parties then 
as now, though partisanship as we know it, did not then 
exist. Our profession had eleven members in the 
National Congress and eight in the State Legislature. If 
the same proportions to total membership in those bodies 
held, we would have today a very large number in both 
bodies. But during the past half century our profession 
has had only a few representatives in either, public politi- 



APPENDIX TO THE MINUTES. 229 

cal position not being congenial, or possibly they are of a 
class rather too independent to suffer the dictation of 
party leaders and have not therefore been wanted, and the 
people have given little thought concerning their own or 
their country *s great need of the conservation of national 
and state health through the physical and mental strength 
of its citizens. Certain it is that the politicians have 
exercised little thought or care. We have today in the 
U. S. Senate one physician and in the House of Repre- 
sentatives nine, only two of whom were practicing when 
elected, the others having retired after brief professional 
experience and entered upon other business years before 
their election to Congress. Massachusetts has no physi- 
cians in her State Senate and but one in the lower 
House ; New York has two in the Senate and none in 
the lower house ; Pennsylvania has two in the Senate and 
seven in the lower House ; New Jersey has one in the 
Senate and one in the lower House. Our State Senator 
is an able practicing physician ; our Assemblyman retired 
from practice and has been conducting a chemical labora- 
tory for some years. Our words here are, therefore, not 
so much in praise of the patriotism in this direction, 
except in the period of the Revolutionary War and the few 
years following, because it has had so little opportunity 
to manifest itself ; rather are they words of warning and 
entreaty. We are conscious of the fact that we are 
addressing intelligent men who are not noted for extreme 
partisanship ; it is contrary to their training and the pro- 
prieties of the profession, whose patriotism rather finds 
expression in that daily exercise, in the direction we have 
indicated, which is telling incalculably for the good o{ 
our country, in seeking the highest welfare of its citizens. 
But there is a duty we owe our country beyond the 
manifestation of faithfulness in our professional work, 

16 



230 MEDICAL SOCIETY OF NEW JERSEY. 

devotion to the poor and service on boards of health and 
education. We know that there are no questions which 
come before Congress and our legislatures and municipal 
bodies of more vital importance than those which con- 
cern the health and moral condition of the people. Our 
times call loudly upon us, as members of an educated 
profession that has of right the guardianship of public 
health and of public morals, in so far as they affect public 
health, to exercise our patriotism in earnest endeavor to 
prevent legislation which threatens not only the health 
and vitality of our people in the present and coming 
generations, but also the destruction of our liberties. An 
active participation in political affairs is not only consis- 
tent with the largest possible degree of culture and edu- 
cation, but neglect to do so by professional men, is 
utterly inconsistent with a true patriotism and a true 
conception of the privileges and responsibilities of 
American citizenship, which must ever stand for the main- 
tenance of all that is good in civil, political and religious 
life ; an unswerving loyalty to all that is pure and true, 
.and noble and heroic. If to official political position, as 
in legislative halls or municipal bodies, we are called, let 
our activities be mightily exercised in saving our country 
from the dangers that are insidiously threatening its ex- 
istence, or at least are weakening its physical and mental 
and moral healthfulness and robustness, and so tending 
to lessen its power and glory among the nations of the 
earth. If physicians cannot give themselves and their 
time to the service of their country in political positions, 
•or are not wanted in such service by party leaders, let 
their influence at least be exerted in the selection of men 
to serve in our Congressional and State halls of legisla- 
tion, and by all means, in our municipal bodies, who know 
something of the science of government and who have an 



APPENDIX TO THE MINUTES. 23 1 

intelligent conception of the people's needs; men who 
know no boss but conscience and will obey its enlightened 
dictates ; men who will be as fully devoted to the physi- 
cal, mental and moral requirements of the people as to 
their commercial or financial interests ; men who neither 
buy nor sell votes, who love country more than party, and 
therefore will strive to secure and maintain good govern- 
ment. We will then have far less legislation for private 
and party purposes, more discriminating legislation for 
the advancement of the public good, larger appropriations 
for worthy purposes and yet far lighter taxation ; far less 
corruption and therefore cleaner and loftier politics, and 
we hope a speedy destruction of the open saloon with its 
iniquitous treating customs and its pernicious influence 
in politics. We believe the saloon is doing more to 
undermine and destroy the physical and mental, as well 
as the moral health of the nation than any other cause, 
unless it be the social evil with its resultant, far-reaching 
and destructive disease — syphilis — which we heard Dr. J. 
Marion Sims refer to years ago as " rarely mentioned in 
polite society even by medical men, and yet is a greater 
scourge than yellow fever, cholera and small-pox com- 
bined." We believe there is no more patriotic service 
our profession can render our beloved country than by a 
positive, determined, continuous effort for the destruction 
of the mighty trinity of evil — political corruption, the open 
saloon and the social evil, for there are no inimical influ- 
ences comparable to these which threaten the nation's 
life and well-being. 

We must express our belief that the public welfare 
would be greatly advanced by the entrance of able medical 
men — men of experience, good judgment and influence — 
into our legislatures and Congress. We realize how 
essential public health is to the public welfare and how 



232 MEDICAL SOCIETY OF NEW JERSEY. 

ignorant or indifferent the ordinary legislator is as to the 
need of any special care of the health of the people, especi- 
ally when any considerable appropriation of money is 
asked to secure it. This has been demonstrated again and 
again. In Congress efforts have been made for years to 
secure a National Board of Health, which would be of 
incalculable value and a blessing to our country. These 
efforts, however, have thus far been unsuccessful. We 
will not discuss the reasons why, but only express our 
belief that fear that it might interfere with the schemes 
and ambitions of others, and the failure in a former 
measure that was defective in conception and plan, are 
the two serious (?) obstacles that areallowed to jeopardize 
the lives of millions of our citizens. The ambitions of no 
man or body of men should be considered. As to old 
failures, we belive that our able sanitarians, profiting by 
the mistakes of the past, are abundantly able for the task 
of providing a new law which will overcome all honest 
criticism and meet all requirements. 

In a letter we received recently from U. S. Senator 
Gallinger, he says: "My sincere conviction is that it 
will be a long time before the legislation you call my 
attention to is secured. It is much more likely that the 
Marine Hospital Service will be granted additional powers 
and that the national health affairs will be kept in the 
hands of those who are now at the head of that bureau.*' 
We are at least thankful that the efforts to secure the 
national board have stimulated Congress to consider the 
matter of public health more fully than ever before and 
make much larger appropriations for health measures^ 
but we desire Congress, the medical profession and the pub- 
lic, to realize that these appropriations have been almost 
entirely for the Merchant Marine of the United States, 
for quarantine purposes, the investigation of epidemic 



APPENDIX TO THE MINUTES. 233 

diseases in Havana, etc., under the Marine Hospital 
Service, and any additional powers granted will not 
enable that department to do the systematic and thorough 
work that a national board of health, with proper adjust- 
ment of relations with state boards of health, would be 
able to accomplish. The government appropriated in 
1896-97, about three-quarters of a million dollars for all 
public health measures, mainly for the support of the 
numerous hospitals, the twelve national quarantine 
stations, investigations of epidemics, etc., under the 
Marine Hospital Service, out of nearly three hundred 
millions total appropriations. Certainly it would seem if 
141 millions could be afforded for pensions and scores of 
millions for river and harbor improvements in the interest 
of commerce (and possibly, in some cases, to advance poll* 
tical fortunes and ambitions), that at least five millions 
could be spared and would be most wisely appropriated 
in caring for the lives and health of the citizens of this 
great republic, by the establishment of a national board 
of health, though no such large sum has been asked or 
suggested. 

It seems to us that the question is very largely 
as to whether the great, the vital interests of the United 
States in matters pertaining to the public health, 
shall be circumscribed in their scope and field of opera- 
tion, and shall be committed to men likely to be swerved 
by political or personal ambitions, who will seek to build 
up a strong medical aristocracy with autocratic powers 
that will enable them to enter any State and exercise 
their supreme authority over State departments, or 
whether we shall have a public health department estab- 
lished on a purely scientific basis and conducted by scientific 
men solely for the advancement of the health interests of 
this country, in a manner that shall be in consonance 



234 MEDICAL SOCIETY OF NEW JERSEY. 

with and shall conserve our republican form of govern- 
ment, and shall in its operations, embrace the whole 
country in the advancement of public health by all means 
essential to that end. We believe there should be a com- 
missioner of public health appointed by the President 
of the United States, and a medical congress or commis- 
sion, consisting of one able sanitarian from each State 
and Territory appointed by the Governor; that they 
should meet, in brief session, in Washington, say once in 
every four months, said commission to formulate the 
laws under which the work shall be carried on, and the 
commissioner to carry out such regulations as the con- 
gress or commission shall establish, with such limited 
powers as emergencies shall require. 

It is patent, we think, to every disinterested, intelligent 
person who desires the attainment of the highest and 
best ends, that some such method will avoid, as the 
Marine Hospital Service will not, all conflict of authority 
and lack of cooperation between the United States and 
the respective States, and will insure the greatest effi- 
ciency. In our own State, out of four and a half million 
dollars appropriated the past year, $15,425 were given for 
the work of our State Board of Health, though the 
$12,000 appropriated for the Dairy Commission and the 
$5,000 for the Commission on Bovine Tuberculosis, were 
largely in the interest of public health. To the credit of 
our last legislature be it said, that in their very proper 
spirit of economy, appropriations for this most important 
work of the State were not only not diminished, but $3,000 
additional appropriation was allowed for the bacteriologi- 
cal laboratory work of the State Board of Health, 
making in all $15,425, as above stated, and that the 
appeal of this Society, through our efficient committee, 
for an epileptic colony for New Jersey, was successful 



APPENDIX TO THE MINUTES. 235 

and an appropriation of $15,000 secured for it. We con- 
gratulate the Society and the State on this latest effort 
of the Medical Society of New Jersey for the amelioration 
of the condition and the restoration of health to many, 
of this most unfortunate class of our fellow citizens, 
which has been so speedily provided for and which action 
is destined to bring added honor and blessing upon our 
beloved State. 

Again we urge the display of that patriotism which, in 
its enthusiasm, obeys the injunction of wisdom — " Prove 
all things; hold fast that which is good," the latter being 
as important as the former. We would emphasize the im- 
portance of caution in making or accepting hasty state- 
ments of half knowledge. 

I. Concerning the general practitioner and the special- 
ist. For example, rash and hasty statement is made that 
because the science of medicine has been wonderfully 
developing and expanding, and knowledge is increasing 
so rapidly, therefore " the general practitioner must go." 
It is not a logical sequence except in individual cases. 
Or because the specialist is a one-sided man who magni- 
fies his specialty unduly and brings many cases wrongly 
within the scope of his specialty, or occasionally treats 
his brother practitioner non-ethically, therefore the 
specialist is a fraud and a delusion. It is not a logical 
conclusion as to specialists in general, though it may have 
an occasional individual application. We quote a more 
careful way of stating belief which is more correct and 
carries greater conviction. J. M. Da Costa, M.D., LL.D., 
of Philadelphia, said in a recent address : *' One of the 
best results of the achievements of our time is seen in the 
effacement of the strict division between medicine and 
surgery, or rather in the recognition that there are* no 
lines separating them, but lines becoming continuous, on 



236 MEDICAL SOCIETY OF NEW JERSEY. 

which joint action proceeds. We see this in the whole 
ch'nical history of appendicitis and its progressive unfold- 
ing ; the more the medical part is studied and rendered 
precise, the more exact becomes the indications for opera- 
tion and the appreciation of the chances of this. The 
same may be said of abscess and of the tubercle of the 
kidney, of the investigations of the character of effusions 
into the pleural, or pericardial or peritoneal cavity, and 
of many other well-known conditions that surgeons and 
physicians are now studying together. This new tend- 
ency is sure to counteract not only the excessive specialism 
of our day but to give us once more broader physicians 
and surgeons, taking the keenest interest in each others 
work." 

These words are worthy our thoughtful consideration. 
Specialism may be true or false. We believe that the 
legitimate specialist is at the same time a cultured and 
competent general practitioner who elects to devote his 
time and faculties to research in some particular branch. 
We owe much of our present knowledge and many of 
the brightest conquests over disease to such specialists, 
and the intelligent and persistent labors of such today 
are being devoted to the elucidation of problems that 
very intimately affect and give great promise concerning 
the health and welfare of millions of people, /. ^., we note 
the great advances in neurology and opthalmology, 
bacteriology, etc. The general practitioner is not ignor- 
ant of these advances, and is not only-reaping the benefit 
of the specialist's work, but in very many cases contribut- 
ing data which is helpful to the specialist and which 
enables him to obtain successful results. 

2. Concerning the family physician. We believe 
there is no field for the manifestation of genuine patri- 
otism, and in which the true, conscientious physician can 



APPENDIX TO THE MINUTES. 237 

"do more to bless his country, than here. Dr. John G. 
Holland says: " In the homes of America are born the 
children of America, and from them go out into Ameri- 
can life, American men and women. They go out with 
the stamp of these homes upon them, and only as these 
homes are what they should be, will they be what they 
should be." Another has said: ''The strength of a 
nation, especially of a republican nation, is in the intelli- 
gent and well-ordered homes of the people. The founda- 
tions of good citizenship are laid there. It must be 
admitted that the American home is undergoing a 
change and that the position and influence of the 
physician, and we may add the pastor, and even the 
parent, in the family is not what it was. 

In fact the old time custom of having and confiding in 
the family physician who attended parents, children, and 
-often the grandchildren, seems to be giving way to the 
desire for frequent change of physicians, or to the custom 
of each member of the family employing a different 
physician, or what is far worse, the growing tendency to 
seek the advice of the druggist or accept that of the 
intimate friend instead of early calling the physician. 

Does it mean serious detriment to the family, the 
community and the nation? Lack of time forbids argu- 
ment; we ask careful thought to the following: (i) The 
value of a thorough knowledge of the family his- 
tory as to hereditary tendencies, the predisposition or 
susceptibility of the different members of the family to 
certain diseases, the character, course and complications 
of their past illnesses, their idiosyncrasies, intolerance of 
•certain medicines, etc., etc. ; (2) The cause and cure, or 
prevention, of the amazing amount of infantile and early 
childhood mortality ; (3) The probable effect of handing 
-over to the midwife the care of mother and child prior to. 



238 MEDICAL SOCIETY OF NEW JERSEY. 

at and for weeks or months after confinement, the serious- 
results often to the mother, and whether it secures to the 
young babe and growing child the best start in life^ 
physically and mentally; (4) Whether it tends to hinder 
our health authorities in the prevention of disease or its 
spread. 

We believe the ideal family physician should be the 
health officer of the home and should be consulted on all 
matters relating to its health, physical and mental, and 
moral as far as the latter affects health. Do not the older 
among us recall the homes of childhood in the years 
gone by, and do we not understand and fully appreciate 
the remarks of the Hon. Reuben A. Miller, when, in 
addressing the Kentucky State Medical Society last year,, 
he said : 

*' I cannot unduly magnify the high and priestly office 
of the family physician, but in the sharp and perilous- 
crises of life, especially in that dark hour when the home 
was hushed and when loving hearts are waiting to be 
blessed with hope, or broken with despair, his very 
presence is an inspiration, and his words of encourage- 
ment come like a benediction. This tender relationship 
endears him to every hearthstone and virtually incorpor- 
ates him into every family circle." 

Lastly, and most earnestly, we urge a fuller attendance 
upon and a more hearty support of the District Medical 
Societies by the members of the profession, in their 
respective counties, as an evidence of their appreciation 
of the dignity of their profession and their loyalty to it,, 
as one of the efficient methods of expressing to the 
public their manhood and patriotism, and as one of the 
means of securing for scientific medicine that respect of 
our fellow-citizens of which it is worthy. In our cities, 
probably, the formation of a medico-legal society — as in 
New York city where it has proved so beneficial — or 



APPENDIX TO THE MINUTES. 239 

possibly even a medico-clerico-legal society would be 
productive of even more good than a purely medical 
society. We are all supposed to be working, or ought to 
be, for the highest public good. We have much in 
common as professional men, and there should be a 
better understanding of each other and their work, and 
more hearty sympathy and co5peration of the members 
of these .three learned professions in all that pertains to 
the public welfare. Meeting together to discuss public 
measures intended for the betterment of the physicaU 
mental, moral and social condition of their fellowmen,. 
and working together, purer and more helpful legislation 
could be secured contributory to these high ends and the 
greater good of the community, the State and the nation 
be attained. 

Another suggestion we intended to discuss briefly, but 
the already too great length of this address forbids, we 
only mention it — the securing in the near future of a 
building owned and occupied by the Medical Society of 
New Jersey, preferably at the capital of our State, with 
library, museum and possibly laboratory for scientific 
research, open to the medical men of our State. It 
would be most fitting that this Society, full of years and 
of most honorable record should, at its 150th anniversary, 
be in possession of such a building. We urge it upon 
the attention of our members, especially those who are 
likely to leave large estates, as worthy their consideration. 

Do not such considerations as we have presented this 
evening, even though very imperfectly, demonstrate the 
nobility of the profession to which we have the honor to 
belong? Shall we not do what we can to make it more 
honorable and respected in its service of country and 
humanity? Though we may be but humble members 
bearing no conspicuous part, shall the aim be to make 
ourselves the more worthy of the honor it reflects upon 



240 MEDICAL SOCIETY OF NEW JERSEY. 

its membership? Faithfulness to its excellent Code of 
Ethics, which simply means that we are honorable men 
and gentlemen, and a more true and hearty esprit de 
corps are two of the important means to the attainment 
of that aim. One of our most honored Presidents, a 
highly cultured Christian gentleman, who presided over 
our centennial anniversary —Abraham Coles, M.D., LL.D. 
— delivered an address on "Man, the Microcosm/* which 
evinced poetic talent of the highest order and is worthy 
a lasting place in our literature, and from which I take 
the liberty in closing to quote: 

" O ye, devoted to the Healing Art, 

By solemn consecration set apart 

To be the ministers of God above 

In the sublime activities of love ; 

Whose special function 't is to give relief 

In the dark hours of suffering and of grief; 

Between the living and the dead to stand 

Where fall the shafts of death on either hand. 

Without one thought of flight, to still maintain 

Perpetual battle with the Powers of Pain ; 

With a fine arrow from a well bent bow 

Transfixing fatally the murd'rous foe, 

And with an arm made powerful to save. 

Snatching the destined victims of the grave. 

The lofty nature of your office such. 

You cannot magnify the same too much — 

Which Tully, even, eloquently lauds 

As that which lifts man nearest to the gods. 

* it * * * « 

* Knowledge is power,* and here *t is power to save, 

A power like God's, to rescue from the grave. 

Each year adds something— many things ye know 

Your sires knew not a hundred years ago. 

Art grown to more, your sons will higher climb, 

And make the coming centuries sublime ; 

Till Christ's millennial kingdom shall begin, 

And put an end to sickness and to sin." 



ESSAY. 



BY WILLIAM PIERSON, M.D., ORANGE, N. J., THIRD VICE-PRESIDENT* 



The Umbilical Cord. 

Although, from the early history of medicine to the 
present day, the management of the umbilical cord after 
the birth of the child, has received its full quota of con- 
sideration, yet no settled plan of treatment has been 
agreed upon. The teachers in obstetrics of the present 
day, differ as widely in their instructions on this subject 
as they did a hundred years ago. A subject so eminently 
practical is worthy of the consideration of the medical 
profession, and if this paper should succeed in calling 
out the personal experience of the members of this 
Society, it will have accomplished all that is expected. 

Upon the establishment of respiration, the function of 
the placenta is ended ; henceforth it is a useless append- 
age, to be cast off forever. In the lower animals the 
cord is torn from the body by the struggles of the off- 
spring or bitten by the mother. The Indians do not 
sever the cord until the placenta is expelled. The 
Japanese tie close to the body and the cord is carefully 
preserved and laid aside with family archives until the 
child arrives at adult age, when he constantly carries it 
about, and it is finally buried with him. Two hundred 
and fifty years ago Guillimeau, in his work on the happy 
delivery of women, says the instruction to the mid wives 
was, '* If it be a boy make him good measure, but if it 
be a wench tye it short.** On this theory a long stump 
favored a long tongue and privy member, and a short 
one a tongue less free and the natural parts more straight* 



242 MEDICAL SOCIETY OF NEW JERSEY. 

At the present day there is a wide difference of opinion 
in the profession as to the distance from the abdomen at 
which the cord should be tied. Some cut close to the 
abdomen, others three or more inches from it. Among 
many of the savage or barbarian tribes the cord is never 
tied. Perhaps if the stump is left of considerable length 
and is crushed, chewed, torn or cut with some dull instru- 
ment, the ligature may not be a necessity. Indeed, in 
the literature of this subject we find from time to time, 
attempts have been made by various obstetricians to do 
without the ligature, but the practice has not been well 
received, and is not in use to any extent at the present 
day. The plan of non-ligation was, and I think may still 
be, in vogue at the Women's Hospital at Philadelphia. 
The cord is not cut for some time, the placenta being put 
into a basin beside the child in its crib and left until the 
physician is ready to attend to it. 

There are still many excellent authorities who claim 
that the non-ligation treatment has many advantages. 
They insist that the navel has a better formation and 
that there is less irritation than when the ligature is 
•employed. The plan is to tear the cord through roughly, 
when a few drops of blood would ooze and the bleeding 
would cease altogether. Dr. Clark, of Brooklyn, after 
adopting the treatment of non-ligation in a number of 
cases, reached the conclusion that the method had no 
advantages over that ordinarily employed. Whether the 
necessity for tying the funis exists or not, it is the almost 
universal custom to tie it. In my own practice I have 
invariably used the ligature. Even when it has been 
employed with the utmost care I have known a few 
instances when a hemorrhage has occurred which caused 
the death of the child. A few drachms of blood will 
soil a large amount of white clothing, which may cause 



APPENDIX TO THE MINUTES. 243 

tnuch consternation in the family and prove more annoy- 
ing to the doctor by a l\^sty summons than dangerous to 
the child. If for no other reason than to prevent such 
an alarm, it will be well always to tie the cord. 

The next question of importance in the consideration 
•of this subject is, how soon after the birth of the child 
-shall the cord be ligated? Hippocrates* instructions 
were that the navel string should not be cut ** until the 
•child has either sneezed, pissed or cried." This, so far 
as the crying is concerned, seems to be the common 
practice of the present day. The rule is to tie the cord 
as soon as the child commences to cry. Ordinarily, this 
may be a good rule to follow ; still there have not been 
wanting in recent times warning voices against precipitate 
action. The average amount of placental blood, accord- 
ing to many careful observers, when the cord was tied 
immediately after the birth of the child, was three ounces 
greater than when it was tied several minutes after 
■delivery, Thus it will be seen that by too hasty tying 
of the cord we may rob the child of much blood which 
would otherwise pass into the circulation which may be 
needed for the establishment of the pulmonary circulation. 

There are obstetricians, however, who take a directly 
•opposite view. Dr. Audrejew, twenty years ago, taught 
that the children in whom the cord was tied one to one 
and one-half minutes after birth, suffered less physio- 
logical loss of weight and more readily increased in 
-weight than those in whom the cord was tied late — two 
minutes after the cessation of pulsation. Audrejew 
•claimed that the increase of blood which the child 
obtained by the late ligation was only about thirty-eight 
grammes. His views have been accepted by only a few 
observers. 

There appears to be no harmful results to the child. 



244 MEDICAL SOCIETY OF NEW JERSEY. 

growing out of the practice of late ligation, so it would 
seem preferable in all cases not to be too hasty in sever* 
ing the child from the placental attachment. It has been 
my rule not to tie the cord until the child has breathed 
vigorously a few minutes, and when there is no occasion 
for haste arising out of the condition of the mother, to 
wait until the pulsation of the cord has ceased altogether. 

The material to be used for the ligature is of more 
practical importance than is generally supposed. When 
the cord is large and its gelatinous contents abundant 
and firm, more than ordinary care must be taken in tying 
or the vessels will not be occluded, and as the cord 
shrinks the ligature becomes loose, and occasionally 
secondary hemorrhage occurs which may prove fatal. 
Silk, linen, catgut, elastic rubber, all have their advocates. 
My personal preference is the narrow linen bobbin which 
has been thoroughly sterilized. With this you may 
apply considerable force in tying without risk of injury 
to the vessels from without inwards. With the silk liga^ 
ture, I think, except with great care, the vessels are liable 
to be wounded and as a consequence a serious hemor- 
rhage may occur. The catgut is unsuitable on account of 
the rapidity with which it rots. The elastic ligatures I 
have had no experience with. Its use is highly com- 
mended by some teachers, and theoretically we may 
regard its use favorably. 

The necessity, or at least the advisability, of the liga^ 
ture treatment being conceded, we have next to consider 
at what distance from the abdomen should the ligature 
be applied. Here, again, authors and practitioners differ 
widely in their views, varying from close to the abdomen 
to three or four inches from it. Ramsbotham advised 
that the ligature be applied about two inches from the 
child's navel and a second one near the placenta, at about 



APPENDIX TO THE MINUTES. 245 

the same distance from the first that the first is from the 
body of the infant. This rule seems to be the one in 
usual practice. Churchill, Lusk, Thomas, Clay, Chad- 
wick, Leishman and Goodell are among those who advise 
that the stump be left from two to three inches in length. 
Playfair, Meigs, Byford, King, Dawson, Mrs. Mary Jacobi, 
Emmet, Wallace and Potter are among those who prefer 
a shorter stump. 

Two reasons are urged for the long stump— rfirst, to 
avoid tying a loop of intestines which might be protrud- 
ing into a perforated funis; second, to leave room for 
retying in case of hemorrhage. The first condition rarely 
exists, and if it should it may readily be avoided by 
careful examination, or by temporarily tying a few inches 
from the abdomen and subsequently retying after the 
child is washed and the physician has more leisure. The 
second reason is insufficient, for a second ligature may be 
as readily applied close beside or within one-eighth or 
one-fourth of an inch from the first as at a greater 
distance. I recall on one occasion arriving at the house 
just after the birth had taken place, and the nurse had 
severed the cord with scissors close to the fold of integu- 
ments forming the umbilicus, and I had no difficulty in 
grasping the cord with a dressing forceps and applying 
the ligature. The advantages urged for the short stump 
are less dead tissue, less fetor, the stump shrinks down 
and sinks into the umbilical depression becoming a mere 
scab or crust, and not being prominent like a long stump, 
is less liable to get pulled or torn from rough handling. 
My preference is for the short stump, for the reasons 
just stated. 

The funis being tied and cut, we naturally come to the 
consideration how it should be dressed. Here, again, we 
find a great diversity of opinion in the methods in use, 

16 



246 MEDICAL SOCIETY OF NEW JERSEY. 

from the old woman's way of folding the cord in a 
scorched, greased rag and tightly binding down under 
the belly band, to no dressing whatever. Dr. Fallen, of 
New York, used for many years a rubber thumb stall as 
a dressing for the cord, which protected the cord from 
irritation and remained on without any fetor whatever. 

What we wish to accomplish is the separation of the 
cord and complete cicatrization of the umbilicus, and 
by so doing lessen the risk of septic disease. How to care 
for the stump so that these results may be best obtained, 
requires an intelligent understanding of the physiological 
changes which naturally occur. Here, again, we are 
confronted by various theories promulgated by distin- 
guished observers in this specialty, which are at great 
variance with each other. It is generally taught that the 
cord putriiies and ulcerates off at the navel, but there is 
high authority for believing that it does not, if left dry, 
putrify, but dries and shrivels up. Vogel says : *' Dessica- 
tion occurs only in the living child. If the child dies 
soon after birth, the cord does not dry, but rots." Lewis 
Smith says : ** When properly managed, the cord dessi- 
•cates and drops off between the third and ninth day, but 
if the cord is allowed to remain wet from urine or other- 
-wise, the cord does not dessicate, but decomposes.*' 

Churchill taught that the stump dries up and withers. 
That this is the natural process is proven by observations 
•on the inferior animals or on the human infant by treat- 
ing the stump dry. If, then, this be the natural process, 
why should it not be encouraged? If greased or wet 
bandages encourage putrefaction they should be aban- 
doned. In looking up the subject, I find the use of 
absorbent cotton as a dressing for the stump is in quite 
general use. It is used simply to protect the stump and 
prevent contact with the skin. This mode of dressing 



APPENDIX TO THE MINUTES. 247 

the stump is a great improvement over the traditional 
greased linen rag, but any pad or compress over the 
stump is, in the judgment of many, objectionable, inas- 
much as they confine to it the heat of the body and thus 
tend to keep it moist and prevent rapid drying. 

Free exposure to the air is far better adapted to secure 
the desired result, and the application of some antiseptic 
absorbent powder will prevent all excoriations or chafing 
of the skin. Boric acid powder is the one I usually use 
for this purpose. Of late years it has been my custom, 
after ligation, to rub over the end of the stump a mois- 
tened bi. chlor. tablet. The dressing should be renewed 
daily. 

Dr. GoodeU's method of managing the cord was both 
natural and simple, and his experience was attended with 
markedly good results. His directions were: When 
the child was ready for removal he cut the cord at the 
usual place, and then seized it between the thumb and 
forefinger of the left hand, close to the umbilicus. Hold- 
ing it firmly in this position, he then proceeds to ** strip " 
it with the thumb and index finger of the right hand. 
By this means all the blood and much of the gelatine of 
Wharton is removed. If there are accumulations of the 
latter in projections of the funis, these lobules are to be 
nicked with the scissors and their contents squeezed out. 
The pressure near the umbilicus should now be tempor- 
arily suspended, when the internal portions of the vessels 
collapse. The part was then subjected to a second 
stripping, after which, hemorrhage having ceased, it was 
tied in the usual manner. It was then left entirely free 
without any dressing whatever. The result was that it 
separated without any bad smell whatever, falling off 
*' like ripe fruit/* without leaving a raw stump. 

During the past fifteen years I have followed this 



248 MEDICAL SOCIETY OF NEW JERSEY. 

method, in the main, of managing the cord, and have 
been more than pleased with the results. I prefer a 
shorter stump than he advises — half an inch in length is 
all that is needed. Under the moist treatment the stump 
decomposes, it sloughs off, and this condition may extend 
to the umbilicus which, after the cord is separated, may 
remain an open ulcer which is slow to heal and may 
become a source of purulent infection and danger to the 
child. It has been my misfortune, in the course of my 
obstetrical experience, to meet with several instances of 
this character. Several have died, and I fully believed 
the cause of death was pyoemia by infection through the 
umbilical vessels. 

The pathological investigations which have been so 
vigorously prosecuted in all the various departments in 
medical work, have fully demonstrated that a large per- 
centage of the septic disease which has been so disas- 
trous to the new-born child has found its entrance 
through the atrium of the umbilical wound. For this 
reason the technic and the approved regulations in regard 
to asepsis and antisepsis merit our careful attention. I 
believe all this may be more fully accomplished under 
the dry treatment than in any other manner. The ulcer- 
ation of the umbilicus so often seen is mainly due to 
improper care of the stump, and is much more likely to 
occur when the stump is kept warm and moist than 
under the dry treatment. 

And finally we come to the consideration of the tradi- 
tional belly-band, the necessity for the use of which, until 
of recent date, has scarcely been questioned. It has 
been, and is yet, almost the universal custom to envelop 
the infant's body in a belly-band. But thanks to Profs. 
Byford, King and Goodell, the attention of the profes- 
sion has been called to the fact of the fallacy of its 



APPENDIX TO THE MINUTES. 249 

importance. For years before their death they taught 
that it was not only unnecessary but mainly injurious. 
The reasons urged for its use are: First, warmth ; second, 
to retain the dressing of the cord ; third, to support the 
abdominal walls and to prevent umbilical hernia. If 
warmth be the object of the use, then it may be readily 
discarded and better replaced by extra clothing, as for 
instance, a heavy netted band which may be drawn over 
the abdomen. A band of this character I adopted over 
forty years ago. If no dressing is applied to the funis, 
a retention bandage will be superfluous. 

Is it necessary to give support to the abdominal walls? 
Are not the abdominal walls composed of tough apon- 
eurotic membranes, between which are several muscular 
layers whose fibres traverse the abdomen in different 
directions in a manner that insures the greatest possible 
strength? Indeed, in no part of the body is there so 
complete an arrangement of soft tissues insuring stability 
and permanence. At the umbilicus and inguinal rings 
only is there any defect or weakness, and at these points 
only do the walls give away, except in cases of traumatic 
injury. The use of the band seems to be unnecessary. 
The walls of the abdomen need no support save such as 
nature provides in the development of muscular sub- 
stance. This certainly cannot be promoted by keeping 
the parts at rest by bandaging. The development and 
growth of all muscular substances depends upon the free 
exercise and free play which, in the infant, are produced 
by the acts of respiration and crying. 

Will the application of the binder prevent umbilical 
hernia ? Certainly not if the hernia be due, as is generally 
regarded by surgeons of the present day, to a congenital 
defect of the parts. In the development of the foetus, the 
last part of the peritonaeal cavity is closed into a short 



250 MEDICAL SOCIETY OF NEW JERSEY. 

sac at the navel. Wood, in the International Encyclo^ 
pcedia of Surgery, said : ** Sometimes the reflected tube of 
the amnion, the vagina funiculi umbilicalis, is found to 
pass into the umbilical cord and to contain a portion of 
small intestines at birth. Here is an intro-uterine forma- 
tion of an umbilical hernia rendered more decided and 
kept open by the struggles and crying of the newly-born 
infant. When this condition is detected at birth, it is 
best, after ordinary ligation and division of the navel 
string, at about an inch and a half from the abdomen of 
the infant, to squeeze out of the persistent sac all traces 
of the presence of intestine or omentum, and then tie 
the cord again firmly close to the surface of the abdomen. 
By this means the occurrence of an umbilical hernia may 
be prevented during the cries of the child soon after 
birth.*' The same author says, "The developmental 
tendency to close up the navel opening is very strong 
and requires only a little aid from art to secure its 
accomplishment.** 

If hernia be due to congenital deficiency at the umbili- 
cal ring, and there is a natural tendency for this to be 
repaired by the development of tendinous fibres upon 
muscular exercise of the abdomen, any application of a 
general abdominal band suflicient to have any retaining 
effect upon a presumptive or real hernia, must so confine 
the abdomen as to defeat the very object that should be 
always kept in view, viz., its radical cure. 

May not the band, especially when tightly applied, by 
confining the abdomen prevent an elastic expansion of 
its walls, compress its contents and force them into the 
weaker openings and produce the very thing we wish to 
avoid ? That this is true we have the testimony of many 
clinical observers. Hodge says: " Among the causes of 
umbilical hernia ought to be mentioned the binder usually 



APPENDIX TO THE MINUTES. 2$ I 

applied to the body of the infant. Nurses under various 
pretences often apply it so tightly as to compress the 
intestines and, of course, force them violently against the 
natural openings of the umbilicus and groin/' 

Besides retarding muscular development and the elastic 
expansion of the abdomen, the binder interferes with 
respiration, prevents peristaltic action of the bowels, caus- 
ing constipation and colic and renders the infant gener- 
ally uncomfortable. Being unnecessary and liable to be 
injurious, its use should be wholly abandoned. Nature, 
so wise and complete in all her work, would certainly not 
have left the viscera of the abdomen unprotected, requir- 
ing the aid of art to supply her deficiency. The abdomen 
being the only portion of the trunk unprotected by a 
bony incasement, should afford sufficient evidence that 
nature did not intend the viscera of the abdomen to be 
imprisoned by any artificial incasement whatsoever. 

The anomalies, accidents and diseases of the navel 
cord play a more important role in obstetrics, in my 
judgment, than is usually observed. Death of the fetus 
in the womb is of no uncommon occurrence, yet how 
seldom is the cause of death registered, as one may 
readily confirm if he will examine the records in the 
Bureau of Vital Statistics. Probably most of us may 
plead guilty to the careless way in which we make out 
certificates, being satisfied with simply stating ''still 
birth," instead of giving the cause of the still birth. 
This is very unscientific and should be corrected. I 
believe that ninety per cent, of the deaths in the uterus 
is not an exaggerated estimate of the number induced by 
some trouble of the cord. 

Various anomalies of the cord have been noted. The 
limited time allowed for a paper to be read at this meet- 
ing will permit only a brief epitome of those of most 



252 MEDICAL SOCIETY OF NEW JERSEY. 

clinical importance, among which we may mention those 
in the variations of the size, torsions, knotting, coiling, 
thickness of the cord, implantation to the placental attach- 
ment. The normal length of the cord is about two feet and 
a half. A variation of from no cord to nine or ten feet 
has been noted. In my personal experience I have met 
with several cases in which the cord was over five feet in 
length, but only one over six feet. The no cord cases or 
the cases where the cord was entirely absent, the umbili- 
cus being attached directly to the placenta, are of rare 
occurrence and have only been observed in cases of 
monstrosities. 

Three distinct variations from the normal central 
implantations of the cord have been observed, viz., 
marginal, in which the vessels enter the margin of the 
organ, to be ultimately distributed through its structure ; 
the velamentous insertion, where the vessels pass for 
some distance between the chorion and amnion before 
finally entering the placental structure; the remaining 
variety is where the cord is received into the fold of the 
amnion which it first traverses. The velamentous variety 
is the only one of much clinical importance. This con- 
dition is fraught with considerable danger to the foetus, 
for the vessels being so much exposed are liable to trau- 
matism and rupture, which may cause death to the foetus 
by shock, asphyxiation or hemorrhage before the delivery 
of the foetus can be accomplished. Hemorrhage, how* 
ever, rarely follows avulsion of the cord. This does not 
occur, because of the retraction of the severed vessels and 
closure of their mouths by an overlapping of the jelly 
of Wharton. 

A variation of the thickness of the cord due to an 
increase or decrease of the quantity of the jelly of 
Wharton has often been observed. A decrease in size is 



APPENDIX TO THE MINUTES. 253 

of no clinical importance, but an increase may require 
more than ordinary care in the ligation of the string. If 
tied without first diminishing the size, hemorrhage will 
4>e very likely to occur as the shrinkage takes place. 
There are reports of cases to be found in the literature 
on this subject when the size of the cord was as large as 
a forearm of a baby several months old. A case occurred 
in my practice only a few months ago in which the 
<liameter of the string was an inch and a half. In this 
^case, before the final ligation was made, the size of the 
•cord was reduced to the average condition by the process 
already suggested in this paper. 

Torsion, knotting and coiling of the cord are often 
-observed. Especially is this true in regard to torsion. 
Excellent authorities even regard a certain amount of 
rotation of the arteries around the umbilical vein as a 
normal condition, and the baby is not thereby incom- 
moded. The torsion may be, and not infrequently is, 
sufficient to produce occlusion of the foeto-placental circu- 
lation and thus causing foetal death. This condition rarely 
occurs excepting in great length of cord or when there 
is an excessive dilatation of the uterine cavity. It is 
remarkable to what a degree the twisting may occur. 
Cases have been recorded when the thickness of the cord 
has been, by the twisting, reduced to the thickness of a 
rstrand of ordinary sewing thread and the twists have 
numbered several hundred. 

Torsion of the cord has long been observed and many 
theories have been advanced in explanation of its cause, 
but as yet none have met with universal acceptance. 
Very little is said in the text books about knots in the 
umbilical cord. They are of rare occurrence and when 
they have been observed they were rarely tight knots, 
•usually only loose loops and were of little importance. 



254 MEDICAL SOCIETY OF NEW JERSEY. 

Nothing can be done to prevent their formation, and 
indeed if we knew one had formed, our knowledge of it 
would be of slight value to the patient. Dr. Weston, of 
Chicago, a few years ago reported two cases, each occur- 
ring in the last months of a first pregnancy. In one case 
the mother stooped to lift a heavy object, and as she 
lifted felt an unusual commotion in her abdomen but no- 
movements of the child afterwards; until this accident 
the movements had been as in a normal pregnancy^ 
When the child was born, about two weeks later, there 
was a simple tightly-drawn knot In the cord which 
completely arrested the umbilical circulation. In the 
second case the knots are supposed to have been induced 
by vomiting. The patient became sick at the stomacb 
while in bed at night. She said something felt as if it 
turned around in her, and gradually all fetal movements,, 
which had been unusually strong, ceased. 

Mention is made in the American Text Book of Ob- 
stetrics where a hard square knot that united both cords- 
was found, resulting in loss of both children. Coiling 
of the cord around some portion of the foetus is an 
accident of frequent occurrence, and in a clinical point 
of view it is of immense importance. These coils are 
not always easy of detection. Auscultation and palpa- 
tion, especially rectal, may assist in making the diagnosis. 
The only certain way to ascertain that there is shortness- 
of the cord is to feel it and actually know that it is tight 
and stretched. Coils are observed in one in five or six 
deliveries. If it occurs during pregnancy it may be tight 
enough to induce strangulation of the cord, when deatb 
of the foetus and premature birth may follow. This con- 
dition, so far as my observation and study teaches, is of 
infrequent occurrence, but in parturition the converse is- 
true. Here, not only the life of the child is seriously- 



APPENDIX TO THE MINUTES. 255 

jeopardized, but the length of the cord may be so reduced 
as to cause considerable obstruction to labor. A mal- 
position or malpresentation may be created or the 
placenta may be prematurely detached and dangerous 
hemorrhage may follow. 

How this encircling is induced is still an unsettled 
question. The concensus of opinion seems to favor the 
view that they are usually brought about by some en- 
tanglement of the child with the cord during the period 
of parturition. JThe coils around the neck of the fetus 
are of most frequent occurrence; indeed, statistics show 
that they are observed in twenty per cent, of all births. 
Usually only one or two exist, but reports of cases are 
on record when as many as nine have been observed. 
Five is the highest number I have any record of in my 
personal experience in six thousand cases of labor. 

In all cases if the cord cannot, by gentle means, be 
slipped over the encircled portion, it should be drawn 
down by the finger and a double ligature should be ap- 
plied and the cord severed between, after which speedy 
delivery must be accomplished or foetal death will follow 
and the mother suffer from dystocia. The expedient of 
severing the cord has proved of much importance in 
several instances in my personal experience, and I cer- 
tainly would advise its adoption in cases of this character, 
especially in breech cases, when the funis is shortened by ' 
the coiling or is an anomaly. To save the life of the 
child after severing, the cord, and the trunk has been 
delivered, it is eminently desirable to deliver the head as 
rapidly as possible, and this may be accomplished by the 
use of the forceps applied to the after-coming head. 

Among the many foetal accidents which may induce 
dystocia, prolapsus of the cord holds an important place. 
This accident was known to the ancients and its serious 



256 MEDICAL SOCIETY OF NEW JERSEY. 

character was fully recognized. The literature upon the 
subject is quite profuse, yet, notwithstanding all this, no 
method of treatment for this accident has been agreed 
upon which has materially lessened the death-rate of the 
child, which is about fifty per cent. This accident to the 
cord in labor, so serious to the child, does not subject the 
life of the mother to any hazard, for it in no way com- 
promises her safety. Statistics show that the accident is 
not very common, occurring about once in two hundred 
and fifty cases of labor. 

Formerly all cases in which the cord presented in 
advance of the child were known as prolapse. In more 
modern times we speak of a cord as presenting when it 
can be felt within the still intact bag of membranes, as 
prolapsed when it passes out of the bag after this has 
been ruptured. A prolapsed may develop out of a pre- 
sentation, while in other cases the cord only descends by 
the side of the presenting part with or after the escape of 
the liquor amnion. Expression of the cord is a condition 
occuring late on in labor and signifying a pressing down- 
wards of a loop by the side of the presenting fetal 
head that has already become engaged. The prolapsed 
cord is usually found in the pelvis by the side of the pro- 
montory or else against the lateral wall, rarely at the 
anterior, and most rarely of all, directly in front of the 
promontory. In all the cases which have come under 
my observation — twenty-five in number — the prolapsed 
portion was found to have occurred on one or other side 
of the promontory. 

The causes of prolapse may be foetal or maternal. The 
foetal causes are certain. malpositions and malpresenta- 
tions, as posterior position of the occiput, presentation of 
the trunk, face, brow, the breech, multiple pregnancy and 
anomalies of the appendages. The maternal causes are 



APPENDIX TO THE MINUTES. 257 

deformed pelvis and uterine tumors. A premature rup- 
ture of tfie membranes has long been regarded as a fre- 
quent cause of prolapse, but according to Spiegelberg, it 
is not a cause nor does it render the woman specially 
liable to prolapse, and as such ruptures occur three times 
as often in cases of prolapse as at other times, this must 
be due to both anomalies arising from much the same 
causes. 

The diagnostic signs whereby the prolapse may be 
recognized vary according to whether the liquor amnion 
has escaped or not. If it is a true prolapse — that is, occur- 
ring after rupture of the membrane has occurred — a pro- 
lapse can always be detected. The cord then hangs 
down in the vagina and often escapes beyond the vulva 
and therefore may be readily explored. In a simple pre- 
sentation it may be difficult to detect since the cord, on 
account of its non-resisting nature, recedes before the 
examining finger and is therefore practically out of reach. 
The main point of diagnosis then lies in the discovery of 
the pulsations. In case there is no pulsation to be felt 
in what is supposed to be the cord, then the diagnosis 
must be determined by palpation. In all cases when the 
umbilical cord precedes the head it is highly important to 
determine whether the child is living or not, and to estab- 
lish either, our main reliance is upon the pulse. A 
momentary disappearance of the pulsation is not a suffi- 
cient sign. During the contraction of the uterus it not 
unfrequently happens the pulse creases because the cord 
is then strongly compressed, but it reappears as soon as 
the pain is over. It is important to make examination 
during intervals of pain. This want of circulation in the 
vessels of the cord may continue for several minutes, and 
cases have been reported where the life of the child has 
been saved when the pulsation could not be detected in 



258 MEDICAL SOCIETY OF NEW JERSEY. 

the cord for a half hour. This fact should ever be kept 
in mind, so that we may not relax our effort to preserve 
the life of the child so long as there is a possible chance 
of doing so. Never despair so long as the faintest pulsa- 
tion can be felt in the cord during a pain or the absence 
of the pain, or when the sounds of the foetal heart may be 
heard. This will be the condition when the circulation 
has been interrupted for a considerable time, when the 
life of the child must be extinct. 

As we have already observed, prolapse of the cord is 
scarcely ever of importance to the mother. No question 
of treatment therefore can arise when the child is dead. 
In the care of such cases the accoucheur should act 
precisely as he would do if the complication did not 
exist. As it is the occlusion of the circulation in the 
cord, occasioned by the compression, resulting in asphyxi- 
ation of the child, it is plainly the duty of the physi- 
cian that his energy and skill should be exerted to 
place the cord beyond reach of pressure, or if this cannot 
be accomplished, to withdraw the child from the im- 
periled position. An exception to this rule should be 
observed in cases when the presentation is detected before 
the OS is sufficiently dilated to admit of the finger or hand 
into the womb, and especially if the membranes are in- 
tact. My experience teaches that all such cases do best 
when left to nature, or at least until the os is sufficiently 
dilated to admit of manual exploration. In your effort to 
restore the cord you will be almost certain to rupture the 
membranes and thus allow of the escape of the waters 
which are a great protection against compression of the 
cord. So long as the cord is allowed to float in the fluid 
it is comparatively safe. I recall three instances of this 
character, when the membtanes remained intact until the 
iabor was completed, when all the babies were born alive. 



APPENDIX TO THE MINUTES. 259 

In the case of presentation of the cord in this stage of 
labor the axiom of Blundell, ** meddlesome midwifery is 
fcad," may well be observed. 

The postural position recommended by Deventer, and 
«o ably championed by our very distinguished country- 
man, T. G. Thomas, and which in England, and especi- 
ally in the United States, is universally known as 
Thomas' *' postural treatment," is applicable in all cases, 
and is the one which promises the best results. The only 
disadvantage in this mode of treatment is the fatigue 
which the patient is subjected to by the long continuance 
in so restrained a position. This treatment is applicable, 
as we have already stated, in all cases of prolapse, and 
the genupectoral position is the one best adapted in all 
•cases where manual or instrumental interference is indi- 
cated. If not successful in the reposition by this pro- 
cedure, then an effort should be made to press the cord 
into the superior strait into the hollow of the neck, by 
means of the hand or some of the instruments devised 
for this purpose, and retained in the uterus by being 
hooked, if possible, over some portion of the foetus. If 
the OS is sufficiently dilated to admit the hand this may 
be accomplished with comparative ease. The only instru- 
ment for the replacement of the cord, of which I have 
any personal experience, is the gum elastic catheter and 
ioop as devised by Ramsbothan, and this procedure is 
not, in my judgment, equal to the manual method. If 
the OS is fully dilated or dilatable, an effort should be 
made to replace the cord if pulsation is perceptable in it. 

If the membranes have not been ruptured it will always 
be best to make your manipulation during the absence 
of a pain. By so doing you will lessen the risk of injury 
to the membranes and escape of the fluids. In all cases 
of shoulder or trunk presentation, with prolapse of the 



26o MEDICAL SOCIETY OF NEW JERSEY. 

cord, the delivery of the child should be accomplished at 
the earliest period possible. An instructive case of this 
character occurred in my practice only a few weeks ago* 
On my first vaginal examination the hand and a coil of 
the cord was observed protruding through the vulva. A 
rapid podalic version and delivery of the after-coming; 
head with forceps saved both mother and child. I am 
not aware that symphyseotomy has ever been resorted to 
for relief of prolapse of the cord, but I can conceive of 
instances in which it would be a proper procedure ; for 
example, cases in which the pulsation of the cord is dis- 
tinct and there is every prospect of a prolonged labor,, 
and especially in those cases due to deformity of the 
pelvis. 

I had intended to devote some time to the diseases of 
the cord, but I find that I have already occupied all the 
time I am entitled to. The diseases incident to the cord 
are numerous and of great interest, and I should be glad^ 
at some future time, to have the opportunity to discuss 
this subject with the members of the Sqciety. 



ESSAY. 



BY H. B. COSTILL. M.D.. TRENTON. N. J. 



Uterine Displacements. 

I shall offer no apology for bringing this old subject 
before you, but do apologize for the manner in which it is 
brought and pray you kind indulgence. I am firmly con- 
vinced that few of us, either as general practitioners or 
as gynecologists, fully appreciate its importance. Modern 
methods in surgery have made the invasion of the ab- 
dominal cavity apparently so easy and tempting that we 
are all too apt to be led away by more brilliant opera- 
tions, while minor affairs are overlooked or neglected. It 
is really quite surprising to see how easily, and with 
almost contempt, some of our most prominent men put 
aside the whole subject, and others who consider that the 
uterus has no normal position and that any location just 
so it gets itself within the pelvis, is all that is necessary. 

Before beginning the study of malpositions of the 
uterus, it may be well for us to refresh our minds as to 
the normal position of the organ. The uterus is 
suspended, or to speak more accurately, floats in the 
pelvis on a plain almost perpendicular to that of the 
vagina, or very nearly in the line with the axis of the 
false pelvis. The fundus looking forward, its anterior 
surface resting on the bladder, the cervix pointing towards 
the coxyx, the organ being very slightly curved upon itself 
anteriorly. This is the position usually given as normal, 
but you can readily see that this is merely a relative one, 
subject to change according to the distention or non- 
distension of the bladder. 

17 



262 MEDICAL SOCIETY OF NEW JERSEY. 

UTERINE SUPPORTS. 

The uterus is maintained in its position in the pelvis 
very largely by intra-abdominal pressure acting upon it 
in all directions, but as the greatest pressure is exerted 
from above, the balance is kept up by the support which 
it receives from the vagina below, upon which it rests. 
Its ligaments are the utero-sacral, utero-vesical, the broad 
and the round. All except the latter are duplications 
of the peritoneum. The insertion of these ligaments, you 
will remember, is on a level with, and not above, their 
origin, and so long as the normal relations of the pelvis 
are maintained they are in a very slight degree suspen- 
sory, really acting more like guy ropes. It is from 
this arrangement that the uterus is so easily movable in 
all directions, especially up and down, and this fact can 
be very easily demonstrated by observing the effect of 
respiration upon the uterus with the patient in the knee- 
chest position, the vulva opened by Sims* speculum. 

DISPLACEMENTS. 
VERSIONS AND FLEXIONS. 

The uterus may be displaced forward, backward and 
downward, and laterally, but as the lateral displacements 
are usually due to conditions outside of the uterus, we 
shall not attempt to deal with them here. The anterior 
and posterior deviations are sub-divided, according as 
there is or is not a bending of the organ upon itself, into 
anteversion and anteflexion, retroversion and retro- 
flexion. The downward displacement of the uterus is 
known as prolapsus. There is also a displacement which 
is a combination of forward and backward displacement, 
known as antiflexed retroverted uterus. 



APPENDIX TO THE MINUTES. 263 

CAUSES OF DISPLACEMENTS. 

Anterior deviations. — As the natural position of the 
uterus is that of anteversion, we can pass this condition 
by as non-pathological and requiring no treatment. 

Anteflexion. — This condition which is always found in 
women who have not born children and which is always 
cured by parturition, is, I believe, very much less common 
than we have been taught, and the diagrams found in 
many of our text-books are more diagramatic than accu- 
rate. The symptoms which have been attributed to the 
displacemei}t are, 1 think, really due to a congenital 
stenosis of the internal os and an accompanying endome- 
tritis, and the condition may be, and probably is, caused 
by increased intra-abdominal pressure from tight lacing 
and also from congenitally short utero-vesical ligaments 
is possible. 

RETRO-DISPLACEM ENTS. 
VERSION AND FLEXION. 

Causes are intrinsic and extrinsic. Intrinsic. — First, con- 
genital displacement ; second, anything that increases 
the weight of the organ, such as sub-involution, metritis, 
endometritis, hypertrophied cervix and pregnancy. Ex- 
trinsic. — These are local and general. Local. — Force 
applied direct to the uterus, such as misapplied pressure 
upon the fundus in an effort to express or hasten the 
delivery of the placenta; allowing patients to assume 
the erect position too early after confinement or abortion, 
or on the other hand, keeping them too long and too flat 
upon the back; heavy pads under the binder, sudden 
efforts in lifting, any rent in pelvic floor which allows the 
sagging of vaginal wall, over-distention of bladder, 
general over-work and fatigue, frequent parturition, con- 
stipation and straining at stool, especially with lacerated 



264 MEDICAL SOCIETY OF NEW JERSEY. 

perineum, diseased and prolapsed ovaries and tubes, par- 
ticularly when adherent. 

RESULTS. 

The first results of retro-displacements are imperfect 
drainage, twisting or folding of the broad ligaments, 
retarded circulation, resulting in time in a varicose con- 
dition of the veins of the pelvis; prolapse of ovaries and 
tubes, with subsequent congestion and tenderness and an 
increased liability to disease. 

SECONDARY RESULTS. 

A very important secondary result is, that in the 
altered position of the organ, the intra-abdominal press- 
ure acts almost entirely from above and tends to force 
the uterus downward in the pelvis, so that in retro-dis- 
placement, we have really the first step toward prolapse. 
Another condition, a result of retarded circulation and 
poor drainage, is decreased resisting power to the attacks 
of various micro-organisms. The vagina is more or less 
an exposed canal, into which bacteria of many kind, in- 
cluding streptococci and staphylocci, frequently find their 
way, and while it is probable that the normal healthy 
secretions of both uterus and vagina possess bacteria 
cidal property, but from poor drainage and retarded 
circulation the conditions are altered, we have, to say the 
least, results which make auto-infection very possible. 

SYMPTOMS. 

Symptoms are local and general. Local. — Most com- 
mon of all is backache and dragging in the pelvis, aggra- 
vated by walking and standing, pain in groins and down 
thighs, increased menstrual flow, leucorrohea, constipation 
and painful defecation, uterine tenderness, erosion of 
cervix and irritable bladder. General. — Headache, loss 
of appetite, mental inertion, hysteria, melancholia. 



APPENDIX TO THE MINUTES. 265 

TREATMENT. 

After all, this is the most important part of the subject, 
and while I do not believe that any hard and fast rules 
can be laid down for the management of all these cases, 
still there are some general lines of management that can 
be indicated. The first class, that is so-called anteflexion, 
is very easy to deal with. A thorough dilatation, curre- 
tage and drainage will cure nearly all these cases; of 
course the cause will be sought for and removed. 

RETRO-DISPLACEMENTS. 

Broadly speaking, there are but two classes of these, 
one with and the other without adhesions. In dealing 
with these there is one rule that holds good with them 
all, and that is, if there is a torn perineum, it must be 
repaired. Many of the retro-displacements without ad- 
hesion can be readily replaced bimanually at one sitting 
and will stay or can be retained by a well-fitting pessary, 
but there are others in which the displacement is of longer 
standing, in which there are still no adhesions, but in 
which the. uterus has become heavy from congestion and 
the ligaments stretched. Here the treatment will have 
to be different. It is rarely they can be replaced at the 
first effort, and more rarely will they stay. Of course the 
rule given above as to the perineum, applies here, and 
should it be found necessary to repair a rent in the pelvic 
floor, the uterus should be thoroughly curretted and 
drained at the same time but, given a free pelvis, a 
sound pelvic floor and a retro-displacement of old stand- 
ing, the management should be after this line : The 
uterus should be restored as nearly as possible to a 
normal position, either bimanually or by repositor, 
patient in knee-chest position, and should be retained by 
packing the posterior fornix with antiseptic wool, mois- 



266 MEDICAL SOCIETY OF NEW JERSEY. 

tened with boro-glyceria lo^, lo^ ichthyol in glycerine or 
plain glycerine according to personal preference. This 
not only keeps the uterus forward but relieves congestion 
and lightens the organ, and should be repeated every 
third day until the uterus comes well forward and shows 
a disposition to stay there, or until you are convinced 
that the treatment is not going to be successful ; and if 
not, what then ? This brings us to the question of oper- 
ation, and which operation is better to adopt in dealing 
with these cases — whether to pick up the round liga- 
ment and shorten it in the inguinal canal after the 
method of Alexander, or to open the abdomen and 
shorten the round ligaments within the abdomen as 
practiced by Wylie, Baer and Dudley, or to bring the 
uterus forward and attach it to the abdominal wall as 
generally practiced, or to do Kelly operation, so-called 
suspension from the abdominal wall, or to open the 
anterior vaginal fornix, dissect loose the bladder and 
shorten the round ligaments here, as recently described 
by J. Riddle Goff. 

The objection to the former — shortening the round 
ligaments in the inguinal canal — is, first, that the opera- 
tion must be restricted to those cases that are free from 
adhesions, of which it is at times very difficult to be 
positive ; second, the difficulty of finding the ligaments, 
and lastly, the liability of the operation to be followed 
by hernia. The shortening of the round ligaments intra- 
abdominally would apparently be opened to less objec- 
tion than the former, but results have shown, according 
to the statements of Polk and others, that the comuae of 
the uterus are approximated, resulting in a flexion of the 
falopian tubes sufficient to interfere with impregnation. 
The objection to attaching to the abdominal walls as 
usually practiced, is that the uterus is raised abnormally 
high in the pelvis, the broad ligaments are put upon the 



APPENDIX TO THE MINUTES. 267 

stretch and pain is very apt to follow, distention of the 
bladder is interfered with, and irritable bladder is the 
result. One other, and really the chief objection in 
women previous, to the menapause, is that the fundus 
being fixed, should pregnancy occur the uterus cannot 
enlarge symmetrically, but the posterior wall enlarges at 
the expense of the anterior, rendering miscarriage much 
more likely. The converse of this is also true, that is, 
should pregnancy go on to full term and labor set in, the 
uterus does not contract symmetrically and labor is liable 
to be complicated by malpositions. Post partum hemor- 
rhage is much more likely to occur from the same reason 
— that the uterus does not contract symmetrically. 

These objections of course do not apply to women past 
the child-bearing age. Dr. Kelly's method of attaching, 
or as he describes it, suspending the uterus from the 
anterior abdominal wall, is opened to less objection, still 
it is subject to the same criticism as the method just 
described, for the same reason that the fundus is really 
fixed ; the long ligament which he expects and believes 
he does get, is, to say the least, doubtful. The operation 
which I believe is open to the least objection and which 
I know will yield good results, I would ascribe as utero- 
ventral approximation. The abdomen is opened by a 
short incision as low down as possible to avoid injury to 
the bladder, any adhesions are carefully broken up, dis- 
eased adnexia are removed, the uterus is brought forward, 
two sutures of silk-work gut are passed through the 
fundus, the first, just posterior to the appex, the second, 
half an inch further back. These are then carried 
through the abdominal wall and tied on the outside and 
are allowed to remain from two to four weeks. In this 
time the uterus has acquired a forward habit, so to speak, 
and the intra-abdominal pressure tends to keep it in 
place. 



268 MEDICAL SOCIETY OF NEW JERSEY. 

The abdominal wound should be closed by sutures 
independent of those used through the uterus; these 
should, of course, be removed at the usual time. I have 
resorted to this method a number of times, and in all 
cases the uterus has remained well forward. My friends, 
Drs. Weeks, Cantwell and McGalliard, have informed me 
that they have had like results in cases in which they 
have used this method. In several cases thus operated 
upon, pregnancy has occurred, gone on to full term and 
delivery taken place without any complications whatever, 
the uterus retaining the forward position subsequently. 
This operation has also been described and practiced by 
Etheridge, of Chicago, and Levings, of Milwaukee. The 
other class of retroversions can only be dealt with by 
opening the abdomen, freeing the uterus from adhesion, 
bringing it forward and attaching it in the manner before 
described. 

PROLA'PSUS OR DESCENT. 

This may be of any degree, from a slight descent to a 
complete protrusion of the organ from the body. The 
condition usually occurs in women who have born many 
children and led a laborious life. The appearance of the 
parts in complete chronic prolapse is undoubtedly 
familiar to you all ; the inverted vaginal walls are much 
thickened and often crusted from exposure and have lost 
all semblance to their natural appearance. The uterus is 
hyperthrophied, the cervix congested and eroded ; there 
is nearly always a chronic endometritis or metritis and an 
irritating, foul-smelling leucorrohea. The causes of this 
condition are much the same as have been given for 
retro-displacements, the chief being a laceration of the 
perineum, which allows a sagging forward of the posterior 
vaginal wall, carrying with it the uterus until the fundus 
is carried far enough backward for the abdominal pressure 



APPENDIX TO THE MINUTES. 269 

to be exerted directly upon the fundus instead of upon 
the posterior wall, thus tending to force the uterus down 
through the vagina. 

This prolapse of the posterior vaginal wall, so-called 
rectocele, has been spoken of, and really is a hernia of 
the bowel into the vagina, and if we study the anatomy 
of the parts for a few moments we can readily understand 
this. The perineum being destroyed its resistance to the 
contents of the bowel is lost. The fibres of the levator ani 
muscle are cut so that it does not resist the sphyncter 
fnuscle which contracts more tightly than normal. The 
fecal matter thus finds the least point of resistance in the 
direction of the vagina, and as it is forced down by the 
straining it bulges forward into that canal. Constipation 
is another common cause, especially when accompanying 
laceration of the perineum. Long hours on the feet, 
•carrying or lifting heavy weight. Prolapse may be either 
acute or chronic. The symptoms of the acute are severe 
pain referred to the pelvis and a condition of shock. An 
examination will at once reveal the trouble. The symp- 
toms of chronic prolapse come on more gradually. They 
are, increased backache and bearing down, inability to 
stand or walk, pain down the groin, constipation and 
-cystitis, from inability of the bladder to completely empty 
itself. 

Treatment, — This depends upon the degree to which 
the prolapse has obtained. In the earlier stages, when 
there is little descent and the anterior wall intact, a 
curettage of the uterus and amputation of the cervix, if 
much hypertrophied, together with the closing of the 
perineal rent, will be all that is necessary. When the 
descent is greater and there is prolapse of both vaginal 
walls, together with the sagging of the ligaments, then be- 
rsides the plastic operation upon the vaginal walls, the 
•uterus must be raised and anchored from above, and in this 



270 MEDICAL SOCIETY OF NEW JERSEY. 

case it will be necessary to secure a more firm attachment 
than in the method described for reto-dispIacements;and 
I want to say positively, that the man who depends upon 
his plastic operation alone, will find himself sadly dis- 
appointed. The uterus has lost its balance, it no longer 
floats in the pelvis, but has prolapsed into the vagina, 
and the constantly acting abdominal pressure tends to- 
drive it from the body. The plastic operation does not 
replace the organ, and in spite of a well-meant effort it will 
finally be driven over, or by pressure, destroy the best 
perineum you can build up. To be successful the uterus 
must be raised and restored to as nearly a normal posi- 
tion as possible. 

Dr. F. C. Martin, of Chicago, has described a method of 
ventro fixation which would seem to be adapted to these 
^ases. He secures the uterus by a ventro-utero ligament 
which he forms by taking a strip of peritoneum from, 
either edge of the abdominal incision and carrying them 
through a puncture made in the fundus just posterior ta 
its crest, and which is held in position by a buried cat- 
gut ligature, the abdominal wound being closed after the 
usual method. In cases of complete prolapse when the 
organ is entirely without the body, the only treatment 
that is likely to afford any good result is removal either 
by vaginal or abdominal hysterectomy. By the abdom- 
inal route the relaxed vaginal walls and stretched liga- 
ments can be better taken up, and there would be less 
likelihood of sagging of the pelvic contents than follow- 
ing the vaginal method. Dr. J. M. Baldy, of Philadel- 
phia, has devised an excellent method for obtaining this 
result. The vaginal method has the advantage of less 
shock and it can be more rapidly done. The only excep- 
tions to be made to these methods are in married women 
before the menapause with no family, and in women too- 
old and feeble to stand operative treatment. 



APPENDIX TO THE MINUTES. 27 1 

PESSARIES. 

This much discussed and often abused little instrument 
undoubtedly has a field of usefulness, the scope of which 
has a very large personal element, but if certain rules are 
carefully observed it can be made of service in a great 
many cases, particularly in that class of retro-displace- 
ments in which the uterus can be readily replaced and 
merely needs a little aid to retain it until it acquires the 
correct habit. Here a light, well-fitting, hard rubber 
pessary will often be of much service, but, as I have said^ 
certain precautions must be observed. A pessary should 
never be placed when there is any inflammatory condi- 
tion of either uterus, tubes or ovaries. It should not be 
used till the uterus has been replaced, or, in other words^ 
a pessary is not intended to replace a displaced uterus 
but only to retain it in place after it has been replaced. 
A pessary should not be used sufficiently large as to put 
the vaginal walls on a stretch. A patient who is wearing 
a pessary should not be allowed to be from under obser- 
vation for longer than a month at a time. And now to 

SUMMARIES. 

First. — Any displacement of the uterus that is suffi- 
cient to interfere with the circulation and drainage of the 
organ is a pathological condition and should receive 
attention. 

Second. — Many cases of displacement can be dealt with 
successfully without operative interference. 

Third. — When operation does become necessary, it 
should be our aim to return the organ to as near a normal 
position and condition in the pelvis as possible, always 
bearing in mind that the uterus is naturally a movable 
organ and any fixation of it is abnormal and should be 
avoided whenever possible. 



ESSAY. 



BY WALTER B. JOHNSON, M.D., PATERSON, N. J. 



School Hygiene, with Reference to the Produc- 
tion OF Ocular Disease. 

The subject of school hygiene has engaged the atten- 
tion of scientists for nearly a century, special attention 
having been first directed to improvements in the con- 
struction of school buildings in the year 1800. The 
special consideration, in this country, of the construction 
of school buildings, arrangement of rooms, furnishing 
and lighting, as related to the production of ocular dis- 
ease, was instituted by Dr. Peter A. Callan, of New 
York, in the year 1875. He, after making comparative 
examinations of the eyes of a large number of the 
children of the public schools, concluded that many of 
the methods and plans of construction then in use were 
a menace, not only to the preservation of normal vision 
but also positively injurious to the general health and 
physical development of the pupils. 

His examinations following the observations of foreign 
investigators and being in accord with them, established 
the fact that ocular conditions affecting the refraction of 
the eye were undoubtedly the result of improper hygienic 
conditions in schools, and led from time to time since, to 
further investigations of the subject by many others 
naturally interested. The latest and most exhaustive 
treatise upon the subject of school hygiene as related ta 
ocular disease has been written for the system of diseases of 
the eye, Norris and Oliver, by Dr. S. D. Resley, of Phila- 



274 MEDICAL SOCIETY OF NEW JERSEY. 

delphia. It is extremely comprehensive and should be 
issued as a separate monograph for the use of those 
specially interested in school work. To it we are in- 
debted for many suggestions and much assistance. 

Improvements in some localities have been made in 
school construction, in preliminary and subsequent ex- 
amination of school children and in attention to the 
detail of school work under scientific conditions, upon 
the lines laid down, as a result of the recommendations 
of the many scientific observers who have worked in this 
field. Only in a limited number of instances, however, 
have municipalities seen their way clear to build their 
school houses thoroughly up to the standard of an up-to- 
date scientific requirement. The expenses necessary to 
adequately construct, heat and ventilate, provide sufB- 
•cient air space per pupil, necessary class and auxilliary 
rooms and thoroughly satisfactory sanitary plumbing, be- 
ing so great that school and educational boards are unable to 
induce the municipal financiers to provide sufficient funds 
for the construction of thoroughly up-to-date school 
houses, except in some of the larger cities. The original 
-cost is not the only barrier, for when the acme of our desires 
in all of the scientific requirements are attained, the school 
boards are confronted by a serious increase in the expense 
of maintenance, for scientific methods which accomplish 
results are only operative at a very materially in- 
creased cost. 

The movement has gradually gained in strength, and 
even though it has failed of complete success it has, how- 
ever, resulted in a general improvement in the school 
buildings throughout the country, and in an increased 
-effort upon the part of those who are specially interested 
in the subject, for future improvement all along the line. 
It is difficult, however, to induce the average layman to 



APPENDIX TO THE MINUTES. 275 

appreciate scientific facts, which by them are often con- 
sidered fads of this or that particular individual, who has 
by immoderate consideration of a subject been induced 
to adopt ideas which increase the expense of school 
•construction without providing, as they believe, commen- 
surate health-saving conditions. The general public 
believe that these same health-saving precautions are in 
•effect inoperative and mythical and not calculated to be 
of material benefit, as it is claimed, to our future genera- 
tion. We must, therefore, get as an entering wedge, 
what we can of improvement. There is much that can 
be done without material increase in the expense — the 
igeneral construction, location, lighting, arrangement of 
rooms, sanitary plumbing, and furnishing in a manner 
which will prevent overcrowding, may be easily attained 
as a result of proper consultation and consideration 
before the erection of a school building. The preliminary 
and subsequent physical and ocular examination of 
school children, and their sittings in properly adjusted 
<lesks may be accomplished without difficulty. Scientific 
school armament need cost but little, if any more, than 
inuch of the injurious, improperly arranged material now 
in use. 

The most important and needful adjunct to all of the 
above, which are inexpensive, is the expensive ventila- 
tion. Heating apparatus without ventilation is compara- 
tively cheap of installation and operation, while any 
adequate system of ventilation necessitates expensive 
steam fitting, ample ingress and egress flues, forced 
draughts and the consumption of large quantities of fuel. 
The tendency now is, however, towards the adoption of 
ventilating systems in all new school houses, and the time 
is not far distant when they will be considered an absolute 
necessity; therefore, educational boards engaging in the 



276 MEDICAL SOCIETY OF NEW JERSEY. 

construction of new school buildings and believing that 
the financial conditions will not permit the immediate 
adoption of some approved ventilating apparatus, should 
at least arrange for the construction of ample flues 
appropriate for use in the subsequent installation of a 
ventilating plant. In the interim, such flues could be 
used in a partial manner without material additional 
expense, so as to accomplish at least a slight approach to- 
pure aeration of the rooms. In buildings where direct 
heat radiation is erroneously adopted the air could be 
rendered purer if ingress flues with appropriate dampers 
were furnished for each radiator. The school window 
should only be used for aeration of the rooms when the 
scholars are absent, except through window ventilators 
or the approximating upper and lower edge of the sash, 
or in extremely warm weather, when all of the windows 
in a room may remain open. 

Public sentiment is being rapidly educated. Recogni- 
tion of the value to the physical well-being of students^ 
of properly constructed, lighted, ventilated and accoutered 
buildings for school purposes will soon be general, as is 
already the case in the construction of hospitals, libraries, 
churches and other public buildings in which many 
persons congregate. It is of vital importance that the 
authorities of the State of New Jersey, following in the 
footsteps of worthy predecessors, shall institute an effort 
to have regular, systematic, ocular and physical examina- 
tions of our school children. Other States, and in 
some cases municipalities, have already introduced such 
systems of examination with good effect. An effort has 
already been made in our own State, in the city of 
Passaic. In 1896, ocular examination of all of the 
children of the public schools was made under the direc- 
tion of the Sanitary Committee of the Board of Educa- 



APPENDIX TO THE MINUTES. 277 

tion, Geo. T. Welch, M.D., chairman. A very carefully 
prepared report of the result of the examination indicates 
a preponderance of disease of the eye, and errors in the 
refraction in the earlier built» poorly lighted and ventilated 
schools, over that which was found in the school buildings 
of more modern construction. 

The necessity for direct light in school houses was so 
impressed upon the minds of the committee that a bill 
was prepared and introduced in the State Legislature, 
prohibiting the erection of school houses in the State 
upon plots of ground where it is possible for any other 
building to be erected within fifty feet. The bill failed 
to pass, and I am sorry to learn that a change in the 
composition of the Board of Education in Passaic has 
resulted in a retrograde movement of sanitary matters 
in the public schools. The city of Plainfield, N. J., has 
lately engaged in an effort to adopt regular examinations 
for its school children. None of the other cities of the 
State have, so far as I am aware, ever undertaken such 
examinations. 

At the March, 1898, meeting of the Passaic County 
Medical Society, the subject of school hygiene having 
been brought to the attention of the society by the 
reader of this paper, the following resolution was adopted 
and committee appointed to wait upon the educational 
commissioners of the city of Paterson, in the hope that 
improvements might be made in the new school building 
about to be erected in that city : 

Resolved, That the President appoint a committee to confer with 
the Board of Education and represent to the Board the opinion of the 
Society as to the extreme importance, in the construction of new 
school buildings, of attention to the proper lighting and ventilating of 
school rooms and to other conditions likely to affect the physical 
welfare of the pupils. 

18 



2/8 MEDICAL SOCIETY OF NEW JERSEY. 

Resolved, That Dr. Johnson's paper be indorsed by this Society and 
referred to the committee to be appointed, to be used at their 
discretion. 

The committee appointed were : Dr. Walter B. John- 
son, chairman, Dr. William K. Newton and Dr. Frank E. 
Agnew. They attended a meeting of the Board, were 
pleasantly received and are engaged at present in an 
effort to make suggestions which, it is hoped, will be 
instrumental in making improvements in the construction 
and other features of the new building. 

The city of Philadelphia and a number of our Western 
cities have, through their local Boards of Health or by 
special examiners appointed for the purpose, made 
detailed examinations of thousands of the children of 
the public schools. One of the most extensive and far- 
reaching plans yet devised has been adopted by the New 
York State Board of Health. Pursuant to the report of 
a committee of oculists appointed to consider and advise, 
suggesting the best and most suitable methods of examin- 
ation of school children for ocular defects, the Board has 
appointed Peter A. Callan, M.D., of New York, as con- 
sulting ophthalmologist. He has arranged and the State 
Board of Health issues a schedule for the use of teachers 
in public schools to test the sight of their pupils. The 
schedule and blank forms which follow indicate just how 
the teachers shall proceed with the examination, which 
is so simple in character that any of them will easily 
acquire the ability to carry out the test, and satisfactory 
results are easily obtained. The necessary armament- 
arium is very simple and inexpensive. It consists of one 
card of Snellen's large test type for distant vision, one 
card of Jaegers' small test type for near use, a one- foot 
ruler to measure the near point, and the printed matter 
alluded to above, as follows: 



APPENDIX TO THE MINUTES. 279 

NEW YORK STATE BOARD OF HEALTH. 

Schedule for the use of Teachers in the Public Schools to test the 

sight of their pupils. 



Prepared by Peter A. Callan, M.D.. 
Consulting Opthalmologist of tlie State Board of Health. 

INSTRUCTIONS TO TEACHERS. 

To test the eyes of school children by a simple method. Hang on 
the wall of a well-lighted class room one of Dr. Snellen's test cards. 
Then mark off on the floor a point twenty feet from the card. Place 
the scholar to be examined at the twenty-foot mark. Cover one eye 
with a visiting card or other suitable screen. Then let the pupil begin 
at the top letter of the test card and name each one in regular 
sequence to the bottom line if possible. Transfer the screen to the 
other eye and let the pupil repeat the letters in the same order. 

In the test do not allow more than one pupil in the room at a time, 
otherwise the result may be unsatisfactory. The letters on Snellen's 
test cards are arranged in a geometrical ratio, an angle of tive minutes, 
so that an eye with average visual power ought to be able to see any 
line at the given distance. First, or largest letter on top of the card, 
should be recognized at 200 feet. Second line consists of two letters, 
and should be recognized at 100 feet. Third line consists of three 
letters, and should be recognized at 70 feet. Fourth line consists of 
four letters, and should be recognized at 50 feet. Fifth line consists 
of five letters, and should be recognized at 40 feet. Sixth line con- 
sists of six letters, and should be recognized at 30 feet. Seventh 
line consists of seven letters, and should be recognized at 20 feet. 

In recording the results of this examination, a fraction is used ; the 
numerator indicates the distance of the scholar to the card, and the 
denominator shows the distance that the line ought to be seen in feet. 
If a pupil is able to name each letter in the 20-foot line with each eye, 
then the record should read : Right eye 20-20, left eye 20-20 ; but if 
only one eye sees at the proper distance, and the right is at fault, right 
eye 20-40, or whatever line is recognized, left eye 20-20. 

Not infrequently cases will be met with where none of the letters 
■can be seen at 20 feet ; then the distance of the pupil from the card 
must be reduced until the largest letter is seen, if it is only 10 feet, 
that becomes the numerator 10-200. In testing for near vision, from 
4 to 18 inches, there are special test types provided. Examine one 



28o 



MEDICAL SOCIETY OF NEW JERSEY. 



eye at a time, and see the shortest distance from the eye that the 
smallest type is legible, then slowly withdraw the test card until the 
limit of distinct vision is reached. Blank form A is furnished to 
record all the cases where vision is 20-30 or less. Note on same blank 
all cases of sore or inflamed eyes, squints, etc. Blank B is the form 
to be used in notifying parents or guardians. 

BAXTER T. SMELZER, 

Secretary and Executive Officer, 



14836 



Blank — Form A. 



14837 





PUBLIC SCHOOL No. 


NO. 


NAME 


AGE 


VISION 


REMARKS 


R. E. 


L. £. 











Note. — Under the head of remarks, if the subject has sore or inflamed eyes,, 
squints, etc., the fact should be stated. 



Blank— Form B. 



PUBLIC SCHOOL No. 



Mr.- 



The examination of your (son's) (daughter's) (ward's) eyes, as re- 
quired by the State Board of Health, shows them to be defective, and 
not up to the standard necessary for satisfactory performance of 
school work. You should advise with your family physician, as ta 
the choice of an eye doctor, whom you are to consult in the matter. 

Respectfully, 



14894 



Principal. 



The directions of the New York State Board of Health 
here end. They are satisfactory and easy of comprehen- 
sion. There is one suggestion made by Frank Alport, 
M.D., who devised the system of ocular examination used 
in the Minneapolis schools, which might be usefully 
added to the procedure of the New York Board, which 
is th^ preparation of a card for the use of those unable to- 



APPENDIX TO THE MINUTES. 28 1 

pay for medical services, to be inclosed with the printed 
circular of notification blank, form B, indicating the loca- 
tion of free dispensaries where they could apply for ex- 
amination or treatment. The test card recently devised 
by Dr. Alport and published by Aimer Co., of 65 State 
Street, Chicago, combining test type and instructions 
to teachers for examination of the eyes and ears of the 
pupils, is useful and convenient. 

The importance of systematic physical entrance exami- 
nations at the beginning of school work, cannot be 
overestimated when these facts are taken into consider- 
ation, that about one-fifth of the entire population of the 
country are school children destined for the period of 
about one-third of their natural lives to inhabit, for two- 
thirds of the working hours of the day, buildings used 
for school purposes, the desirabilty of a pupil's physical 
adaptability for the work is easily realized. 

Recent examinations have been made by medical 
inspectors of the Boards of Health in Boston, New York 
and Chicago for the purpose of restricting the attendance 
upon school of children physically unfit or affected with 
infectious or contagious diseases. These examinations 
have shown that there were many scholars in attendance 
not only not in good health, but also many suffering from 
infectious and contagious diseases. In some of the 
Boston schools 25 per cent, were sent home, and in 
• certain classes 75 per cent, of the pupils were found to 
be suffering from pedeculosis capitis. 

The scientific advances will before long necessitate plac- 
ing those who have physical defects in a privileged class, 
where, by a system of selective studies, they may be given 
only the amount of school work which they have the 
physical ability to perform. The physically weak should 
not be advanced to their own detriment and to the detri- 



282 MEDICAL SOCIETY OF NEW JERSEY. 

ment of the physically strong, nor allowed to undertake the 
entire school curriculum as now laid down for all students 
alike, regardless of any consideration of their innate 
strength being sufficient to withstand its strain. 

I do not propose here to enter into a consideration of 
the ability of a child possessing all the attributes, mental^ 
moral and physical, necessary to a school life's work, to 
withstand the strain of the years of close application 
necessary to carry out all of the work of the school system 
as it is arranged in the curriculum of our modern institu- 
tions of learning, but point to the ravages of physical 
and ocular disease which it has been undoubtedly proven^ 
occur in so large a percentage of the students who sur- 
vive the entire course of study, and would certainly 
result in a much higher percentage if the statistics might 
include the many scholars fallen by the wayside in their 
futile efforts to struggle through the course of study. 

The large number of those physically unable to per- 
form the necessary work in its earliest stages or who 
become incapacitated as the years roll on, is an evidence 
that the most painstaking effort should be made in 
arranging the schedule of school work, to fully and care- 
fully consider just what demands could or should be 
• made upon the mental powers of children in the forma- 
tive period of life. While we cannot but admit that 
physical defects are hereditary, and that regardless of the 
adoption of all possible scientific efforts to establish con- • 
ditions antagonistic to the fostering of physical defects, 
they will occur, and that we must admit that under the 
most favorable conditions, numbers of our school children 
will become diseased during their school period. It must 
be recognized as a fact, that it has been statistically 
proven that the ravages of disease are antagonized in the 
more modern school buildings and their extent and 



APPENDIX TO THE MINUTES. 283 

severity lessened and the percentage of healthy children 
augmented. The result of the work of the scientific 
observers of the world indicates that the myopic condition 
and other errors of refraction are the result of ocular 
application, and that the ratio of myopia will be pro 
rata with the call for near work made upon the 
inhabitants of the country in which the examinations 
are made, the precentage in countries attaining the 
highest grade of advanced civilization and intellectual de- 
velopment being as high as fifty per cent., while it has also 
been clearly demonstrated that the ratio increases as the 
student grades from the primary to the higher classes. 

The percentage of myopia in the United States, which 
is apparently about twenty-five per cent., is certainly 
constantly increasing, and the time to use every effort to 
prevent its further increase is now present, and no effort 
can be too irksome for us to make in alleviating the con- 
ditions which are its foundation. In the recent examina- 
tions made throughout the country, of the United States 
Volunteers, the percentage of rejections was high, and it 
is ofHcially stated that the city-bred recruits showed a 
much higher percentage of physical disability, ocular and 
general, than those from the country districts. May not 
much of this be traced to the comparative difference in 
their school life and work ? 

The dangers to the rising generation from these sources 
being fully recognized, can not but impress upon us, as 
humane citizens, the necessity for the encouragement of 
every effort made to induce our commissioners of public 
instruction to perform the work intrusted to them in 
accordance with the best known methods, to build and 
furnish our school houses in such a manner that none of 
the physical defects of our school children may be subse- 
quently traced to dereliction in the performance of their 
duties? 



284 MEDICAL SOCIETY OF NEW JERSEY. 

The question of the erection of new school buildings 
which are necessary to provide for the increasing and at 
present, waiting school population, in all of the larger 
cities of the State, is now being agitated. A bill was 
introduced at the past legislative session by Assemblyman 
Benny, of Bayonne, providing that ample school accom- 
modations should be furnished to meet the present need 
and provide for future development. The bill did not 
become a law in consequence of the opposition of the 
municipalities which recognized the absence of sufficient 
school accomodations but claimed that its provisions for 
the immediate erection of so large a number of schools 
entailed the expenditure of too great a sum of money. 
The bill will, in all probability, be revived at a future 
legislative session. It should then contain provisions which 
will make the purchase of ample plots for new school 
buildings a necessity, and regulate the location of the 
buildings in such a manner that any possible adjoining 
buildings could not encroach upon the light, or space, or 
approach within a given distance of the school house 
walls. 

The ideal school house must be built upon a site 
selected with a view to the possibility of providing 
adequate light supply for every class room in the build- 
ing, and this light supply should be direct and not trans- 
mitted from the walls of adjoining buildings. Corner 
plots should always be given the preference in conse- 
quence of their two sides presenting no possible ob- 
struction to the entrance of light. The direction from 
which light is admitted is important, and the window 
space must be so arranged in its relation to the position 
of the desks, that all light shall enter from the left and 
behind the scholars. Any form of blind or shade which 
will shut out the light instead of subduing it when the 



APPENDIX TO THE MINUTES. 28$ 

•direct sun's rays are entering, is objectionable. The 
relative area of window surface to floor space should be 
at least as one is to Ave. 

The school room window should be as large in area as 
a proper scientific construction of the building will per- 
mit, due allowance being made for strength, heating, 
ventilating and dust flues. All maps, blackboards, etc., 
must be so placed that they shall be directly lighted 
away from the point of light entrance, and so located 
that they do not reflect the light and are easily visible 
from any part of the room. They should present a dull 
surface. Some authorities have suggested the use of 
white surface boards and black crayon for class room 
work, and recently green slate has been advised instead 
-of black. The school room walls and ceilings should be 
tinted in light colors, preferably subdued grays or buffs 
of dead finish, the ceilings being of a decidedly lighter 
<olor than the side walls. The light of a room may be 
materially affected by a proper or improper treatment of 
the walls and ceiling. The importance of proper ventila- 
tion cannot be overestimated. Each scholar should 
have an allowance of about 250 cubic feet of air space, 
and the ventilating apparatus should have a capacity 
which will entirely change the air of each room once in 
^very fifteen or twenty minutes. 

If the ventilating apparatus is inadequate to perform 
"the perfect ventilation of the building, it is more satis- 
factory to depend upon it for aeration of the rooms 
exclusively, as the opening of transoms or windows not 
only interferes with the satisfactory operation of the 
ventilating system, but is dangerous to the health of 
those of the scholars who must be exposed to draughts 
from them. The furniture in the school building should 
he of staple character and of a size proportionate and 



286 MEDICAL SOCIETY OF NEW JERSEY. 

suitable to the grade and growth of the pupil destined! 
to occupy the room for which it is intended. Every 
school desk and seat should be adjustable. They should 
not only be adjustable but should be adjusted in every 
instance accurately, by measure, to the pupil to occupy 
them at the beginning of the school term during class- 
organization. Too much care cannot be taken in the 
proper adjustment of the seats. For all of the evils of 
improperly constructed desks, many come from those of 
the most approved plan if not so adjusted, even if the 
adjustment for heighth of seat and desk is correct and 
the distance should be plus instead of minus, the beneficial 
effect is partially negatived, as such arrangement does 
not insure upright sitting. 

It has been claimed that the custom of specializing the 
work of teachers, which has been adopted in so many 
schools of late, necessitates the passage of the classes 
from room to room and renders it practically impossible 
for each scholar to occupy his own seat, and that the 
removal of the classes was beneficial and gave time to air 
the rooms. The teachers might be moved, it would 
seem, but they object, arguing that it would be very 
difficult to carry with them the necessary armament and 
that much time would be lost in the necessary reproduc- 
tion of their blackboard work. It should, however, be 
possible to evolve some plan of work which would not 
endanger the physical welfare of the pupils, even though 
it were attended by surmountable difficulties. Or, if 
necessary, this departmental instruction, which is not 
in general use, nor entirely successful, might be dis- 
continued. 

Space will not permit full consideration of text books,, 
hours of study, home study, etc., but the adoption of 
the method of arranging the work for the school to be: 



APPENDIX TO THE MINUTES. 287 

performed at the school, and using every effort to make 
the teaching didactic from blackboards, models, etc., is 
recommended, instead of mainly from the near point, as 
was formerly considered necessary. Paper and black ink 
are to be used in preference to slates or lead pencils. If 
light enters from the proper angle the question of the 
straight or slanting handwriting, is not so important, as 
the erect posture may be attained in either by altering 
the position of the paper. The tendency at present, 
however, favors straight handwriting with the pad 
directly in front of the body. There should be roomy,, 
airy, well-ventilated cloak rooms. The toilet arrange- 
ments should be of the most approved pattern and 
durable style, and must be constantly guarded lest they 
become fouled, as the necessities compel that lavaratories,. 
etc., should be used in common. 

Any child applying for admission to a school, having 
reddened or weak eyes, should be at once referred 
to a competent authority for examination as to the 
question of the communicability of the condition before 
admission, or any scholar who develops reddened or dis- 
charging eyes during school work should be sent home 
with a note of explanation, and be obliged to present a 
certificate citing the harmless character of the disease 
and absence of the danger of the infection of other 
pupils before permission to resume school work is granted. 

Physical disease, as well as ocular difficulties, constantly 
result from faulty light, improper position at work, ineffi- 
cient armamentarium and vitiated atmosphere. When the 
conditions are favorable to the minimum disadvantages 
from these sources a most careful inspection should be 
undertaken. Initial and preliminary, general, and special 
examinations of all of the school children should be 
made. A constant supervision should be maintained and 



288 MEDICAL SOCIETY OF NEW JERSEY. 

the pupils should be examined from time to time as they 
advance from grade to grade. Every effort must be 
made to have refractive errors properly corrected by 
glasses, diseased conditions cured and all of the steps 
taken necessary to the physical well-being of the children 
in all school departments. 

It has been suggested and is the custom in many cities 
for Boards of Education or superintendents of schools 
to annually arrange, at the commencement of the school 
year, for one or more lectures upon subjects pertaining 
to school hygiene as related to physical and ocular 
defects, with the object of impressing upon the minds of 
the teachers the importance of eternal vigilance and the 
necessity for the constant performance of their duty in 
-connection with the physical welfare of their pupils. 
While it is certain that many of our school children will 
continue to suffer from one or another variety of physical 
derangement, it is positive that the ratio of diseased to 
comparatively healthy children will be very much in 
favor of the system of prophylactic management here 
suggested, and future generations will profit by the addi- 
tion of many individuals who would be otherwise totally 
unfitted for life's work, possessing mental attainments 
which could never have been developed under the old 
school regime. 



ESSAY. 



BY J. C. APPLEGATE. M.D., BRIDGETON, N. J. 



Regression vs. Progression. Viewing the General 
Practitioner from a Scientific Standpoint. 

It is far from the intention of the author of this paper 
to attempt to prove regression on the part of the general 
practitioner as a whole. We do contend, however, that 
with few exceptions their progressive strides have not 
been in keeping with surgery and other special branches^ 
of the profession. It is true that in the recognition of 
the germ theory of infectious diseases and the germicidal 
properties of certain substances, the world has reached a. 
period in its medical history that our forefathers never 
even dreamed of ; and yet the gernri of most of the infec- 
tious fevers is still a mystery and will ever remain as 
such, until we have learned more of cellular-life processes- 
and the ability of cells to resist invasion. 

Nor do we wish to belittle the position of the general 
practitioner, notwithstanding the fact that many occupy 
places in the profession today who ought to be at the 
plough or anvil, and vice versa, for of the noblest, although 
probably the humblest, of the medical profession is the 
general practitioner. The noblest, because as the family 
physician he is first sought for advice and first taken into 
confidence ; the humblest, because he must ever hold 
himself in readiness to respond to his patrons at their 
will, regardless of time, receiving the minimum compen- 
sation fee for his services. The noblest, because his. 



290 MEDICAL SOCIETY OF NEW JERSEY. 

responsibilities include that of the surgeon, the obstetri- 
cian, the gynecologist and general medicine combined, 
particularly in rural districts; the humblest, because in 
many instances, if scientifically inclined, he has entered 
into a study of his case with precision, while under the 
present craze for specialism, the specialist becomes the 
recipient of the patient, the maximum compensation fee 
and, of course, the glory. 

That the physician of today, having received his 
medical education under improved methods of teaching, 
fulfilling the requirements of State medical boards, is 
more adequately eqipped than his preceptor, ail will 
admit, and yet the bright lights of the medical world 
who have made the important discoveries of recent years 
can almost be counted on the fingers of my two hands. 
If, then, the physician of today, with the superior advan- 
tage of a higher medical education, accepts the established 
principles of the few or waits for some genius to supple- 
ment Lister or Pasteur's discoveries or complete Koch's 
methods, with this open field before him, he is neglecting 
golden opportunities. Is it not true that too often our 
researches decline at the expiration of our demonstrative 
course of teaching, when it ought to be but the beginning? 

To be successful scientists we must be perpetual stu- 
dents and investigators. The physician of the past, 
especially during the earlier history of medicine, was 
looked upon as one of high repute and as a counsellor as 
well as of the healing art. He, too, alleviated suffering 
and saved human life. Although it was not given him to 
see the bright lights that now mark the path of medicine 
and surgery, his works and discoveries are convincing 
facts that he, with his limited resources, did not grope 
entirely in the dark. His position was one of dignity 
and honor, and while the fact remains the same today, 



APPENDIX TO THE MINUTES. 29I 

"he is too often, we fear, looked upon as a medicine 
-peddler, thus engaged for pecuniary reasons rather than 
from natural qualifications for the calling, or, perhaps, 
from ancestral achievements, laboring under the delusion 
that profession is hereditary. 

During the last decade many evils have arisen which 
tend to belittle the profession and to check scientific 
■advancement. These evils singularly have had their most 
rapid growth during an age when the standard of pro- 
ficiency of the student was being raised above that of 
any previous age. When the student of today, having 
•completed his collegiate course, enters upon his life work 
as a general practitioner, he is confronted by numerous 
•obstacles. He finds before him a field overcrowded with 
specialists, many of whom are bona fide and very essential 
for humanity's sake and for scientific advancement, while 
many are simply specialists in name, lacking the funda- 
mental principles attained only by a thorough course in 
the school of practical experience in general medicine. 

An eminent surgeon has said that, ** In the not very 
•distant future each patient would be visited by two pro- 
fessionals, the family physician and the specialist." If 
this be true, where lies the responsibility of the former? 
Dr. Roswell Park, of Buffalo, in his recerrt epitome of the 
history of medicine, says that *' the splitting up of medi- 
cine into specialties has resulted in great danger to the 
unity of medical science, and a return to the methods 
which combine science and practice is again being sought.*' 
A man cannot be a successful specialist unless he is first 
a successful general practitioner, any more than a man 
•can be a successful contractor until he has labored at and 
mastered all of the minor details in connection with the 
^rt of building. 

The general practitioner not infrequently encounters 



292 ' MEDICAL SOCIETY OF NEW JERSEY. 

patients who have suflfered for a brief period, perhaps- 
from vertigo or hemicrania, when inquiry for the brain 
specialist is made, while the cause of the malady exists 
in some remote part of the system — is probably of gastric 
origin ; or from neurasthenia, when the neurologist is- 
given an opportunity to do some scientific guessing, 
while the cause is probably of local origin and ought to- 
be, if in the hands of a specialist, the gynecologist. I 
have in mind a lady, age 45, who gradually became a 
victim of epileptic attacks, which grew from bad to worse,, 
and considering her age, together with the influence of 
friends, she was referred by the attendant to the gyneco- 
logical department of a hospital, but nothing abnormal 
was found in that department as suspected. The special- 
ist on diseases of the nervous system did not succeed in 
giving her relief, and it remained for a humble general 
practitioner to determine, from a careful study of her 
history and condition, to be spinal epilepsy of specific 
origin, who succeeded in giving her entire relief with 
antisyphilitic remedies. 

Do not misunderstand me — I regard specialism as a 
sheet anchor and indispensable adjunct in modern 
scientific medicine. What I do condemn is excessive 
and incompetent specialism which does much to produce 
discontentment among the laity and complicate matters, 
for the physician. Then, too, the universal use of pro- 
prietary medicine endorsed by individual members of the 
profession does much to check scientific advancement. 
Even in this advanced age we still find learning and 
science mingling with ignorance and superstition. In the 
larger cities the public charity and free dispensary abuse, 
unless modified, we predict will, in the near future, cause 
the extinction of the aspiring scientist who is not fortu- 
nate enough to be connected with one or the other of 



APPENDIX TO THE MINUTES. 293 

these institutions. That the motives of the prime movers 
engaged in such philanthropy are good, I doubt not, but 
the effect is often bad. Bad, because it means encourage- 
ment to men who on Saturday night spend their week's 
wages in debauchery, and men who claim that they were 
not born to work, to continue idle, with the positive 
assurance that the good people have provided for them 
in the event of an attack from the dread enemy, disease. 

This evil is unlimited and is detrimental, not only to 
the practical physician and the advancement of science, 
but to the laity as well. It is a recognized fact that the 
difficulties to be overcome are many and strong, the chief 
of which is the determination of the worthiness of appli- 
cants, for it is a well-known fact that the deserving ones, 
who are few in comparison to the myriads who throng 
these institutions whose pecuniary circumstance in no 
wise render it necessary to seek gratuitous advice or aid, 
are usually the most reticent in accepting such assistance, 
so that when the boards of management of such institu- 
tions shall succeed in correcting this crying evil, their 
work will be most commendable and, I believe, will have 
the unanimous endorsement and cooperation of the medi- 
cal profession. As it now is, the general practitioner is 
deprived of much of his valuable material, not simply for 
experimental therapeutics but for scientific investigation 
and practical experience in modern therapy. He finds 
among this class of patients abnormal conditions and 
afflictions which, with his better element, with a higher 
regard for self-preservation and improved sanitary cur- 
roundings, he seldom ever encounters. 

The method in vogue at the present time among 
general practitioners, giving greatest semblance to scien- 
tific regression, is the result of the relationship existing 
between the physician and the pharmacist. The time has 

19 



294 MEDICAL SOCIETY OF NEW JERSEY. 

been when the relative positions of the two were coopera- 
tive — at the present time they are simply operative — and 
it has been said that ** these changes have so profoundly 
altered the position of the physician that it is little less than 
criminal for him to neglect their consideration." While, 
under the present condition of affairs, the physician is 
ci^g«igcd in compounding his own prescriptions or dealing 
out his fixed formulae of various combinations, the phar- 
macist is illegitimately prescribing over his counter with 
freedom and practicing the art of surgery whenever the 
opportunity affords. If he claims to have been forced 
into this policy of aggression, it is in a direction where 
the counterpressure is strongest, for the physician has to 
but look around him in almost any home to discover 
numerous remedies, not proprietary, for various ills, com- 
pounded by the authority of one of his own pharmacists. 
The physician, in turn, has become his own prescription 
clerk, thus broadening his sphere of work and assuming 
responsibilities which properly belong to a regularly 
graduated pharmacist. 

With the beginning practitioner, no better method 
could be adopted than to handle his own medicines, as the 
familiarity resulting from such would undoubtedly be bene- 
ficial to him, while, on the other hand, the established 
physician can better afford to leave this work to an efficient 
and honorable pharmacist, utilizing his time in seeking 
after deeper and more accurate knowledge of the cause 
of disease and the remedies most efficacious for their allevi- 
ation. As a result of this relationship we have been 
brought face to face with a problem which ought to be 
solved, and at once. Can we afford to fill our cases with 
a list of combinations, consisting of tablet triturates and 
solutions recommended and furnished us by both the whole- 
sale and retail dealers, telling us by foot-notes in which 



APPENDIX TO THE MINUTES. 295 

diseases and under what circumstances they are indicated, 
and present ourselves to suffering humanity as scientific 
practitioners? 

Unquestionably, one of the greatest evils from which 
legitimate pharmacy and medicine suffer, is the indiscrimi- 
nate use of fixed formulae in the form of compressed 
tablets or solutions. The pharmacist is not wholly re- 
sponsible for their invasion into the office of the general 
practitioner, as their convenience, portability and cheap- 
ness appeal to many. The ingredients or proportionate 
ingredients of a prescription cannot be intelligently 
decided upon at any other time or place than at a visit 
to the bedside or from a record at the bedside, and not 
months in advance at some manufacturing establishment. 
It seems to me to be an undeniable fact that he who 
would be a progressive, scientific practitioner, granting 
exceptions, must discard the use of fixed formulae and 
decide, after a careful and intelligent study of the history 
and condition of his subject at the bedside, as to what 
his pharmaceutical preparation shall be, or else class him- 
self as a modest medicine peddler. 

The science of medicine is a living, not a dead science, 
and with the suppression of these existing evils no 
reason, to my mind, exists as to why we should not note 
a period in the history of the profession paramount to 
that historical eighteenth century, known as the golden 
age of medicine. History tells us that the practice of 
medicine was then regarded as a conscientious vocation 
and not a mere business or trade, and so it ought solely to 
be today. The man who tells you that he has something 
good to reduce temperature without weakening the heart 
and cannot name the ingredients contained therein, had 
better remained on the farm. History further tells us 
that during that golden age of medicine the profession 



296 MEDICAL SOCIETY OF NEW JERSEY. 

was not overcrowded and there was much less of that 
one-sided, narrow education that obtains today. 

But what shall be the future sphere of the general 
practitioner? Will he, as has been suggested, assume 
the position of an advance agent of the specialist ? Will he 
continue to approve the use of the proprietary nostrums, 
acting as humanity's ** Life Saving Guard," thus lending 
encouragement to a universal custom which is shortening 
the life of man ? Or shall we take a bold stand in favor 
of scientific advancement, making the first decade of the 
twentieth century an epoch in the history of progressive 
medicine hitherto unsurpassed. And in this the general 
practitioner should play a most active part, for in his line of 
the work he daily comes in contact with one disease alone 
which costs the lives of thousands annually. A disease 
which claims for its victims one-eighth of the whole human 
family, regardless of the hand of science. It is more des- 
structive than the Vesuvius and more deadly than muni- 
tions of war. Were he to devote his lifework to this and 
establish treatment which would successfully combat it, 
his life would be well spent. We cannot all be Grosses, 
Flints, Agnews or DaCostas, but he who is first success- 
ful in isolating the bacillus tuberculosis and points out 
the antidote which will effectually neutralize it in the 
human system, will go down in history beside Jenner, 
and his name will be emblazoned on the tablet of fame. 



ESSAY. 



BY LOUIS FAUGERES BISHOP, A.M.. M.D , NEW YORK. 



Chronic Cardiac Disease, and its Management. 

In addition to the treatment of acute diseases, the 
physician is called upon for advice as to the care of con- 
ditions that he cannot completely cure. Then the 
disease is to be modified by submitting the patient to a 
proper regimen. In the case of a heart the subject of 
a particular lesion, the problem is to so modify the con- 
ditions under which it has to do its work that it can 
carry the burden of the defective valves or the diseased 
heart muscle. The care of cardiac disease is the problem 
of the care of invalids in general. The circulation must 
be studied, not alone as to its point of propulsion, but as 
to its whole circuit. We need not consider here the whole 
pathology of the heart with its possibility of multiple 
lesions and conditions. Five points are enough for 
practicable purposes: disease of the mitral valves, dis- 
ease of the aortic valves, hypertrophy, dilatation and 
degeneration of the heart muscle. 

Chronic valvular cases may be divided into two types — 
the aortic and the mitral. In the mitral group are 
included most young persons who have acquired a 
cardiac lesion as a complication of an acute infectious 
disease, and who, while preserving the general appear- 
ance of good health, still are subject to passive con- 
gestion. This frequently gives these patients the high 
color so becoming, but so significant of venous stasis. 
The mitral type is less prone to an increase of the cardiac 



298 MEDICAL SOCIETY OF NEW JERSEY. 

lesion. The aortic type includes in general older people^ 
or at least young people who age prematurely. These 
are apt to become anaemic, to emaciate, to develop 
chronic nephritis and a general arterial schlerosis. 

Many cases will have lesions of both orifices, but will 
classify themselves under one or the other of these types 
of disease. There is probably an underlying consti- 
tutional condition. In a person without a tendency to 
arterial disease, the mitral valve is the more liable to 
suffer in an acute attack, while where there is a tendency 
to endarteritis the aortic valve, situated where it is prac- 
tically at'the beginning of the largest artery of the body, 
is the seat of inflammation. In the management of 
chronic heart cases, it is well to bear in mind these two 
types, because what may benefit the one may be pre- 
judical to the other. The difference is almost the differ- 
ence between rheumatism and gout: rheumatism rep- 
resenting the mitral cases and gout the aortic cases. 

It is not necessary to distinguish particularly from 
the point of view of therapeutics between mitral sten- 
osis and mitral regurgitation. The two conditions 
usually co-exist, and the effect is the same in causing a 
dilatation of the oracle and congestion in the pulmonary 
veins. This is followed physiologically by a hypertrophy 
of the right ventricle in its attempt to sustain the pul- 
monary circulation. Finally, the whole circulation is 
involved in the deficiency and hypertrophy of the left 
ventricle takes place. This hypertrophy is nature's 
effort to combat that venous congestion of all the organs 
to which the French give the name of ** Cachexie 
cardiaquey 

The hypertrophy of a muscle, even though physio- 
logic, is not natural, and hypertrophy gives rise to dis- 
orders of its own. The heart muscle becomes more 



APPENDIX TO THE MINUTES. 299 

liable to degeneration and dilatation. In this instance 
the heart muscle may be compared to the muscular 
system of an athlete of a certain type, and its life's his- 
tory is very much the same. The athlete in early life 
is of normal development. He becomes interested in 
feats of physical competition, and in order to be able 
to sustain the unusual demand upon his muscular 
system undergoes a course of training, resulting in 
the abnormal development of muscular tissues and 
strength. Now, during a long term of years, if he 
maintains systematic exercise, he enjoys good health. 
There comes a time, however, when there is a tendency 
to the development of fat, when the muscles undergo a 
degenerative change, and the man deteriorates, so that 
after middle life, often enough the over-developed youth 
is not the equal in health to the average normal person. 

What we must guard against in the care of compen- 
sated cardiac disease is this tendency to degeneration of 
over-developed structures. Hence the necessity of spec- 
ial care to avoid all those elements of life, such as over- 
work, worry, alcohol, or indolence, that have this 
tendency. 

It is well to draw this line between those cases of car- 
diac disease in which the lesion is in the nature of an in- 
flammation, involving one or more structures of the 
heart, and those in which it is the result of pre-existing 
inflammation and is of the character of a scar. Thus the 
degenerative conditions, such as the weak heart, following 
the abuse of alcohol or over^vork, with the schlerosed 
valves that go with this condition, should be classed with 
the inflammations. The deformed valves following an 
acute inflammation in the course of rheumatism, scarlet 
fever or any other infectious disease, may come to a 
permanent condition of induration, and during the 



300 MEDICAL SOCIETY OF NEW JERSEY. 

remainder of the patient's life undergo no change of 
mechanical importance. It is obvious that in the care of 
these two classes of cases there must be wide differences. 
In the former there is a progressive condition with a 
grave underlying constitutional degenerative tendency 
that must be combated in every possible way. In the 
latter the heart is acting at a disadvantage, owing to the 
waste of force caused by the flowing backward of a 
certain amount of blood at each systole. Still, as the 
provision for the circulation is a good deal above the 
minimum demand of the body, under ordinary circum- 
stances, the damaged heart does its work very well. The 
natural compensation without the stimulus of develop- 
ment is sufficient in these cases. On the other hand, in 
the degenerative cases much benefit is often derived from 
a systematic course of hydrotherapy and exercise, such 
as may reawaken an active metabolism and change the 
balance of the tissues from a destructive to a constructive 
plane. 

The relation of gout to chronic cardiac disease is a 
topic of interest. Gout is to be sought in that type of 
cardiac derangement in which the arteries and kidneys 
are also involved. The heart suffers primarily in these 
cases as a result of arterial tension, which produces hyper- 
trophy. Later, the heart muscle itself may become the 
seat of myocarditis and the valves may suffer hardening 
of the san^e nature as that of the arteries. Clinically the 
cases of cardiac disease also divide themselves very much 
into those in which the heart muscle is at fault and those 
in which there is primary disease of the valves. How- 
ever, whatever its origin, in its later stages heart disease 
is a complex combination of an exhausted and failing 
heart muscle, insufficient valves, anaemia and blood stasis. 
As might be expected, cases of myocarditis result in a 



APPENDIX TO THE MINUTES. 3OI 

laxity of the cardiac orifices, giving an opportunity for 
the regurgitation of the blood, causing murmurs of 
insufHciency, while the anaemia is accompanied by those 
other murmurs so often found in that condition. 

Second in importance to the signs of defective circula- 
tion come disturbances of the heart's action. Without a 
more definite knowledge of the physiology of the heart, 
and without understanding more thoroughly the wonder- 
fully successful mechanism that keeps nearly every heart 
beating regularly, it is not easy to explain cases in which 
the heart has lost its rythum, so that the pulsations differ 
in force one from another. The study of the significance 
of the irregular pulse is of importance because a prog- 
nosis is necessary to the administration of a proper treat- 
ment, and the outlining of a suitable plan of life. In 
this category of irregular pulse the very slow pulse may 
be included. Many cases have their significance made 
plain by well-defined accompanying lesions. When 
stenosis or regurgitation, hypothophy or dilation, fatty 
degeneration or myocarditis are present, the question of 
irregularity of heart action is easily overshadowed in im- 
portance by that of the practical efficiency of the systole 
to maintain the circulation of the blood. The cases 
which puzzle most are those unaccompanied by definite 
lesions, which we like to believe are of constitutional 
■©rigin, meaning by that to a defective physiology or of 
neurotic origin, being the accompaniment of general 
neurasthenia or other defect of the nervous system. 

Congestion has effect both direct and remote. Thus, 
•congestion of the liver undoubtedly has a broader influ- 
ence upon the whole economy than we are prone to believe. 
Nor do the results of chronic congestion resemble those 
of the acute condition. This great organ, presiding as it 
•does over the chemistry of the blood, when congested, 



302 MEDICAL SOCIETY OF NEW JERSEY. 

produces that general condition called bilHousness. Bil- 
liousness always seems like bad ventilation. The blood 
circulates through the liver again and again, without be- 
ing supplied with those elements that favor its healthy 
matabolism, and which seems to be essential to its proper 
purification. In addition to this, the liver has the direct 
function of producing the bile, the natural primative 
laxative. The organ is found enlarged, and sometimes 
its functions are interfered with to such a degree that 
the patient is somewhat jaundiced. 

Until compensation is re-established, congestion of the 
liver can only be ameliorated. The functions of the liver 
must be stimulated, from time to time, by appropriate 
means, but local applications as to the chest should not 
be neglected. The congestion of the kidneys, in the 
early stages, is benefited by the effect of digitalis on the 
circulation, but later when there is albuminuria, the condi- 
tion must be treated as a case of nephritis. 

Chronic cardiac disease is not to be considered as val- 
vular disease alone. This is contrary to analogy of the 
same class of lesions in other parts of the body. When 
a joint becomes the seat of chronic arthritis, the tissues 
of the remainder of the limb are frequently involved. 
The care of cardiac disease during the period of quiesence 
of the valvular lesion is the care of the myocardium. 
Hypertrophy of the cardiac muscle and dilatation of the 
cardiac sack must be understood. That is, hypertrophy 
that goes beyond the degree that is desirable in a heart 
with damaged valves. Excessive hypertrophy is best 
avoided by a regular hygienic life and by systematic 
watching for every cause that may increase the burden of 
circulation. Dilatation is the condition that the heart 
reaches when it struggles under the burden of a circulation 
too great for its weakened myocardium. Instead of a firm 



APPENDIX TO THE MINUTES. 303 

contraction, almost empyting the heart at each stroke^ 
the systole only partly expels the blood and symptoms 
of impaired circulation are evident. Dilatation is usually 
gradually established, occurring at intervals for a time* 
from a sufficient cause, and then, perhaps, disappearing. 
However, cases of acute dilatation, even in those 
previously unaffected by cardiac disease, are not at all 
rare. 

The importance of physical ease to persons afflicted 
with severe valvular disease is so great that it frequently 
determines the continuance of life itself. A boy who 
had been under observation for about three years, died 
a few weeks ago simply, it seemed to me, because his 
circumstances were such that he was unable to lead a 
purely invalid's existence. Attacks attributable to failure 
of compensation uniformly followed a course of physical 
exertion. When promptly treated by rest in a hospital 
he recovered, only to have another attack when he 
returned to his work — that of an errand boy. Finally, he 
became somewhat accustomed to the dyspnoea, a compli- 
cating bronchitis and the oedema, so that before his last 
illness he deferred treatment so long that the passive 
congestion seriously involved the kidneys. This was 
plainly shown by the character of the oedema, which on 
this occasion involved the face as much as the dependent 
portions of the body. 

This fact led me to a bad prognosis, because experience 
has shown that in these chronic cases when, in an attack 
of oedema, there is evidence of a serious involvement of 
the kidneys, the chances are great that a fatal termination 
is near. The importance of occasional periods of rest 
for these chronic cases is great, but when return to 
physical labor is necessary a relapse can only be expected. 
Nor must the fact be lost sight of that too long periods 



304 MEDICAL SOCIETY OF NEW JERSEY. 

of inaction may make the resistance to labor less, and so 
really lower the average condition of the patient. 

To illustrate a typical case of myocarditis, take the fol- 
lowing: A man of forty- five years of age came to my 
clinic yesterday, giving the following history : His health 
had always been good until seven years previous. For a 
good many years before that he had been a free drinker. 
There was no history of pulmonary weakness or specific 
disease. Seven years ago he began to notice that he could 
not take much exercise without losing his breath. At the 
same time he discovered that his pulse was irregular and 
intermittent. Still he was able to go on with his work, 
being for long intervals of time free from symptoms, his 
chief complaint being that he was unable to stand any 
unusual physical exertion. During the past year the 
breathlessness and the irregularity of the heart's action 
have become more marked, so that at the present time 
he is unfit for any kind of labor. He has taken a great 
deal of medicine without any apparent benefit, and his 
stomach only supports the simplest food. 

The physical examination shows a man of large frame, 
well nourished and apparently robust. It is noted, how- 
ever, that there is pretty marked cynosis of the face and 
hands. The examination of the heart is not satisfactory 
— it seldom is in these cases. The sounds are distant 
and indistinct; the apex beat cannot be clearly made 
out. In examining him one has a feeling as if tryingto 
see something through a mist. What we actually do find 
is that there is an absence of a distinct apex beat. The 
heart sounds are extremely irregular in force and rhythm, 
and there are murmurs to be made out, but it is hard to 
be sure just how they are produced. In this case 
they are short blowing murmurs over the base of the 
heart and over the lower half of the sternum. 



APPENDIX TO THE MINUTES. 305 

If these patients are put on doses of digitalis that are 
effective, the heart regains its power, the apex beat 
returns, the individual contractions are more distinct, and 
definite signs of mitral insufficiency or aortic murmurs 
appear. In this particular patient the disease was 
probably complicated by a cirrhotic liver, the liver being 
considerably enlarged. The treatment of these cases is 
not satisfactory. The hope of cure can hardly be enter- 
tained after they have gone on so long. The best thing 
that can be done is to so supervise their mode of life and 
administer cardiac stimulants so that they are able to live 
comfortably. With a life of absolute regularity the heart 
can go on, even in its crippled condition, to do its work 
for a long time. 

Causes of local congestion, whether displaced or in- 
flamed organs, or overloaded viscera, must be treated 
with the greatest care in cardiac cases. Chronic constipa- 
tion is a foe of these patients ; it must be met by diet, 
training and, as far as necessary, by drugs. The cure of 
constipation is only possible in those individuals who 
have sufficient mental force to appreciate and carry out 
a regimen. Constipation is a vice of indolence as often 
as it is a physical defect. There is no better illustration 
of the influence of the mind than the relief of constipa* 
tion by the re-establishment of the normal habit of 
evacuation through the application of the will. A very 
good plan is to administer the fluid extract of cascara in 
a single large dose at bedtime, instructing the patient ta 
repeat the dose every night for a month, but to modify 
the amount to exactly that quantity that will cause a 
single satisfactory evacuation. At the end of the month 
the patient is instructed to continue the established habit 
of daily evacuation, but gradually reduce the cascara a 
few drops each day until the dose is perhaps five or six 



306 MEDICAL SOCIETY OF NEW JERSEY. 

drops. This minute quantity is continued for its moral 
effect for a time, to be gradually abandoned as experience 
proves that it is unnecessary. This gradual withdrawal 
of laxatives in the cure of constipation seems to be 
essential to success. 

The attempt to cure by intermittent catharsis always 
fails, while the plan outlined has been successful in the 
cure of a number of cases, even in confirmed invalids. 
If laxatives must be resorted to again at any time, the 
patient is instructed to repeat the same process — not to 
take a single large dose to be followed by a temporary 
diarrhoea and subsequent constipation, but to take the 
drug for a series of days, gradually abandoning it. The 
evils of constipation in chronic cardiac cases are so great 
that the introduction of this subject is entirely justified. 

The idea of influencing the course of cardiac disease 
by physical means is no new thing, and yet there is 
hardly any therapeutic system with a basis so radical 
that has been as frequently advocated and then discarded 
or neglected by leaders in the profession. The reason 
for this is not altogether clear, but may in part be traced 
to the injudicious claims of over-enthusiastic advocates. 
That an organ so easily reached by impressions from the 
surface of the body, and so quickly affected by any 
muscular act, should be influenced for good or for evil 
according to the character of these impressions or exer- 
tions, is reasonable. That it is easy to predict the results 
or judge the effects of any particular system is not, how- 
ever, to be expected. Whatever theories may be held in 
regard to the action of baths and exercise, the final 
conclusion must be arrived at by the study of results. 

Here we approach the most difficult obligation that 
falls to the lot of the student of scientific medicine, but 
one that cannot be avoided. The advocates of the 



APPENDIX TO THE MINUTES. 307 

Schott system, for instance, bring forward convincing 
evidence to prove that there is great improvement under 
•exercise when carried on slowly and regularly, the move- 
ments being at the same time resisted by the physician 
or trained attendant, who carefully regulates the degree 
of resistance in accordance with the condition of the 
patient. The chief effects claimed are a slowing of the 
pulse and a dimunition in the size of the heart. The 
plan of treatment is not recommended in cases of aneur- 
isin or where there is a high degree of arterio-capillary 
fibrosis with high tension. Nor is the exercise all of the 
treatment. The patients also receive baths containing 
abundant mineral constituents, chiefly the chlorides of 
sodium and calcium. At first the baths are given at the 
temperature of 92*^ to 95^, lasting from six to eight min- 
utes. Afterward, the proportion of solids is increased, 
the temperature is lowered, and free carbonic acid gas is 
present in abundant quantities. 

The baths most frequently employed in the system of 
Schott are those of Nauheim, but it is acknowledged 
that the same conditions can be reproduced artificially 
by employing a mixture of salts similar to that contained 
in the natural water, and by generating carbonic acid 

m 

gas in the bath with bi-carbonate of soda and hydrochloric 
acid. The resistance exercise is intended to bring into 
action almost every collective system of voluntary 
muscles. The patient is made to breathe slowly and is 
told to inform the operator of any approach of palpita- 
tion. The attendant resists each prescribed movement 
with a force that falls just short of what would be neces- 
sary to arrest it. Thus the patieat is practically exercis- 
ing with an intelligent resisting apparatus. 

The general skepticism of the profession as to the claim 
is founded, as is so frequently the case, upon the appar- 



308 MEDICAL SOCIETY OF NEW JERSEY. 

ent inadequacy of the cause to produce the results 
claimed in the conditions supposed to be present. It 
must, however, be acknowledged that bathing, controlling 
the capillary circulation and stimulating and toning up 
the nervous system, should be beneficial in these cases. 
Again, no more judicious or more easily regulated system 
of exercise should be devised than resistive movements. 
As to the results, it is only natural that the advocates of 
a system should be over-confident. Indeed, were not 
this the case, it would be difficult for any novel method 
to be pushed into general notice. The suitable cases are 
benefited, persist in treatment, and in cases of relapse,, 
return again. The unsuitable cases very soon disappear 
and resort to other physicians. The cases in which the 
Schott system seems to be beneficial are so difficult to 
manage that we should give a patient trial to a method 
that has so much of reason and evidence in its favor. 

Unfortunately, in this country at least, physical 
methods of treatment of disease have too often fallen 
into the hands of the unscrupulous, who have treated 
those sent to them unfairly, and it is difficult to know 
how, with the patient of average means, to obtain the 
appliances for physical measures. It would seem to be 
the duty of one or more of the hospitals, and of the men^ 
who have the privilege of working in them, to provide 
apparatus and make a test of this method on the impar- 
tial basis. If it is all that is claimed for it, there are 
thousands of cases who should receive the benefit of it. 
If it is not, it is equally important that the truth should 
be known. 

Passing to another class of patients that may be rightly 
classed as cardiac, we come to the overfed, under-exer- 
cised, dissipated man of middle age, who has begun to 
suffer from marked shortness of breath. There is no- 



APPENDIX TO THE MINUTES. 309 

valvular disease, but the heart and the whole system is 
so loaded with fat that the heart is unable to do 
its work. For these patients, nothing better can be 
recommended than a course of training. There is near 
New York an ex-prize fighter who has done much good 
for such men. A man of strong character and accus- 
tomed to dealing with and ruling pugilists, he has trans- 
ferred his talents to these overfed people. 

In the treatment of the heart overloaded with fat, the 
patient is put through a course of training, which includes 
early rising, cold bathing, douching, rubbing, horseback 
riding, punching the bag, plain food — chiefly meat and 
bread — and early hours. It is surprising how much a 
severe course of training will do in a short time for a man 
of good physique who is simply overloaded with fat and 
deranged as to his disgestion by indiscretions of diet. 
The decision as to the proper exercise for a person with 
chronic valvular disease is not so easy. Inactivity, while 
it may relieve the heart of much work, leads to passive 
congestion, sluggishness of function on the part of the 
organs, and a loss of the advantages to the circulation 
that come from the stimulation of the peripheral vessels 
by the movements and activity of the tissues through 
which they run. 

In the care of chronic cardiac disease, even in the 
intervals between severe crises, certain drugs have a use- 
ful place. Thus, is cases in which there is a tendency to 
hardness of the pulse and the signs of the beginning of 
an arterial schlerosis, the use of sodium iodide is valuable. 
It should be used more frequently than it is in combina^ 
tion with digitalis. It counteracts the well-known effect 
of digitalis in contracting the small arterioles. Nitro- 
glycerine is also valuable. The effect is only momentary, 
but it gives the heart a chance to catch up for the short 
20 



3IO MEDICAL SOCIETY OF NEW JERSEY. 

time during which the peripheral vessels are dilated. 
The use of iron in of chronic heart disease does not 
give the same results as in some other conditions of ill 
health. It should be given only where anaemia is a 
marked symptom. Some cases of anaemia simulate very 
closely cardiac disease, presenting as they do, dyspncea, 
oedema and a cardiac bruit. In these, brilliant results 
are obtained by the use of iron, but the very improve- 
ment is enough to confute a diagnosis of cardiac disease 
as the primary element. 

Digitalis should not, as a rule, be given, except where 
compensation fails. The proper use of digitalis requires 
careful consideration, and there is no important drug in 
connection with which so much diversity of opinion and 
practice exists. The trouble begins with the student, 
who learns its physiological action to the exclusion of its 
therapeutic effects. Its preparations are frequently un- 
certain and its dose is not accurately determined. Digit- 
alis should not be given in a routine way as a matter of 
form, but pushed in some efficient preparation until 
actual signs of its action is apparent, or symptoms of 
poisoning, such as vomiting, appear. If it must be con- 
tinued for a long time, it is conveniently administered in 
one large dose at night. 

In combating passive congestion, the auxiliary benefit 
of local treatment must not be lost sight of. The great 
propelling force of the circulation is the heart, but the 
activity of local circulation can be increased by special 
stimulation. Thus, in congestion of the lungs, the appli- 
cation of counter-irritation to the chest by meai>s of 
mustard and the stimulation of hot poultices, produce 
more than temporary benefit. Dry or wet cups act in 
the same way. Local congestion of the lungs is also 
somewhat influenced for good by expectorants and 



APPENDIX TO THE MINUTES. 31I 

emetics. I have frequently thought that if a particular 
patient suffering from the pulmonary congestion of 
chronic heart disease could be made to vomit actively, 
that the local congestion would be much relieved, but I 
confess that I have never tried the experiment, in the 
face of the danger of exhaustion. Every one knows 
the benefit of vomiting in relieving congestion of 
the larynx of children in croup. 

There will be times in the course of cardiac disease 
when, from a neglect of proper precautions, the heart 
lags in its work, and symptoms of deficient circulation 
manifest themselves. Thus, when a patient allows 
the general health to get below par through dissipation, 
over-work or exposure, there may be developed dropsy 
of the lower extremities, breathlessness and more or less 
cyanosis. The clear indication is to treat the patient by 
rest in bed, plain diet and heart tonics. Cjilomel is fre- 
quently given with the idea of relieving congestion by 
depleting the intestinal tract. It is undoubtedly valu- 
able, but never produces the magic effect that many 
claim for it. Recovery takes place from these symptoms 
of cardiac insufficiency with a rapidity proportionate to 
the reserve force of the heart. Even the damaged heart 
has some reserve force, and it is the over-demand 
that has caused it to fail in its work. The recumbent 
position makes the circulation more easy to carry 
on ; a milk diet and free catharsis relieves the gastro- 
intestinal canal of much of the burden of digestion ; car- 
diac tonics conserve and develop the force of the heart, 
and in a few days the patient is on his feet again. If he 
be wise he will have learned a lesson — that he must re- 
model his whole existence to correspond to the available 
energy of his damaged heart. What he lacks more than 
anything else is reserve force, so all causes of sudden 



312 MEDICAL SOCIETY OF NEW JERSEY. 

Strain should be removed. Whatever his work may be, 
it should be evenly distributed over the day and a strict 
system of life rigidly adhered to. Sleep is of essential 
importance and rest is desirable. Thus, many men go on 
for years with impunity, bearing the necessary duties of 
life, because they are willing to forego the unnecessary 
strains. They learn to control the emotions, to avoid 
anger and escape worry, to put away from themselves 
inordinate ambition and to seek their pleasures in simple 
ways. Indeed, it is an interesting question whether 
some of these individuals who are limited in their possi- 
bilities by a crippled heart do not evolve a sounder phil- 
osophy of life than many who do not recognize the limita- 
tions set upon their achievements by lack of reserve 
power in other directions. 

Whatever may be the teaching of theorists and 
preachers t9 young men, the fact is physiologic that 
many persons are limited by deficiency of reserve power, 
whether in the nervous system in general or in the brain» 
or in the physical constitution, so that it is well that 
society is so constituted that many of its members must 
fill places in which their labor is fixed and laid out for them. 
They are unable to meet strains, intellectual, moral and 
physical. Few of them recognize their limitations, as 
does the patient with the damaged heart, under the in- 
structions of his physician. In the older countries, fixed 
social conditions impose barriers that make it easy for the 
masses to accept their lot. In this country, the teaching 
that any individual may overcome by force of labor the 
circumstances of his position in life, while it tends to the 
development of the few, it also tends to the discontent of 
the majority. True contentment and happiness is for 
those who can form a just conception of their reserve 
force and adopt a plan of life according to it. Unusual 



APPENDIX TO THE MINUTES- 313 

abilities justify unusual undertakings, while average 
capabilities are most happily exercised under average 
conditions. 

The effect of climate with special reference to altitude 
on cardiac cases, must be studied a good deal with refer- 
ence to the individual. When the valvular lesion is 
grave, it is essential that the patient should remain at a 
comparatively low level. On the other hand, in many 
cases in which the circulation is well carried on, but with 
persistent murmurs, with the probability that anxmia is 
at least a strong factor in their production, the patients 
improve much in a high sunny climate. Whatever may 
be the reason, it seems to be agreed by climatologists 
that removal to a high altitude has the immediate effect 
of increasing the red blood corpuscles. The theory of 
this is not established. I would suggest that the rarified 
air brings a diminished amount of oxygen to the lungs, 
therefore creating a demand for more corpuscles to 
gather in oxygen for use of the system. It would be 
foolish, however, to multiply theories without special 
studies. 

It is not necessary, except as to altitude, for every one 
who needs a change of climate to make a change of resi- 
dence. A change from an indoor to an outdoor climate 
is a great deal a matter of volition. The open windows 
at night and the waking hours spent out of doors, with 
the adaptation of home-life to the system that would be 
found in places especially resorted to for health, would 
approximate closely in results what is accomplished by 
health resorts. Too often the means for a change of 
climate are said to be lacking, when knowledge and 
moral force are really the elements needed. 

In the feeding of patients with chronic cardiac disease 
or in whom the heart is embarrassed from any cause, the 



314 MEDICAL SOCIETY OF NEW JERSEY. 

question of quantity is important. Discomfort and 
derangement of the stomach, by the ingestion of too large 
a quantity of food, with the evolution of gas pressing on 
the diaphram, may be avoided by causing the person to 
eat more often than the customary three meals a day 
and less at a time. Any excess of carbo-hydrates 
must be avoided. The advantage of the relief to the 
circulation of a diminished ingestion, of fluids has long 
been under consideration. The ability of the kidneys to 
very quickly take care of any over dilution of the blood 
does not negative the ill effects of the temporary burden 
of an over-weighed circulation that the heart must 
contend with. 

The influence of the mental health upon the course of 
cardiac disease is well shown by instances of persons with 
cardiac disease who go on in comparative comfort for 
years, through the cultivation of even living and quiet 
thinking. This is especially true of the heart damaged 
by acute disease in early life that has placed a limitation 
upon the possible activities, that when recognized, has 
become a fixed principal in the life of the individual. 
These patients who adapt themselves to the inevitable are 
not made unhappy thereby, but are often rather spared 
the irritation of the average man who believes that his 
progress is retarded by his own indolence. 

It is important to dispel from the mind of the cardiac 
patient the notion that his chief danger is a sudden 
death. He should rather be instructed that the proba- 
bilities are, that if he dies of his heart trouble the 
death will be gradual, and he should be warned that the 
first part of the descent from the plane of good general 
health marks the danger point. He must be taught 
to believe that in him, disturbances of digestion, loss of 
color, malnutrition and particularly dyspnoea and oedema 



APPENDIX TO THE MINUTES. 315 

of any kind, should immediately result in the overhauling 
of his plan of life and system of treatment. 

If we have not dwelt particularly upon the brilliant cure 
of disease, we have at least considered the care of an im- 
portant class of patients. Unfortunately, it is not possible 
always to hope for the removal of disease, therefore we 
must from time to time devote ourselves to the study of 
the best means of caring for chronic cases. This work 
falls to our lot as general practitioners, who are in the 
majority of our profession. Specialists stand in the 
public mind for active interference and brilliant results in 
selected cases ; the family doctor, for the care and protec- 
tion of the individual and the management of conditions 
that cannot end in recovery, or that are cured without 
the necessity of parade or brilliant surgery. 

In fact, the treatment of heart disease is the treatment 
of the whole body in each of its divisions. The effects 
of it simulate in each organ the simplest form of disease, 
namely, congestion, and the hygiene of heart disease 
calls for an exercise of the most direct principles of 
hygiene, because it finds each organ by its congestion, 
threatened with disease, the character of which is not 
pre-determined. The physician must stand in relation 
to the patient with chronic heart disease as the captain 
does to the ship— constantly guiding, and not as the 
occasional pilot taken aboard when special dangers 
threaten. The physician has the power to save him from 
dangerous conditions, but each time at the loss of reserve 
force and with the prospect of a sooner return to the 
same danger. Far better is it for the physician to be put 
in charge before the rocks are encountered and disaster 
is threatened. 



ESSAY. 



BY PHILANDER A. HARRIS, M.D., PATERSON, N. J. 



The Dangers of Certain Faulty Impressions 
Regarding the Menopause. 

The "change of life," the climacteric, the "critical 
time," and the menopause are the more common terms 
for that condition in women which is especially character- 
ized by the complete and permanent cessation of men- 
struation. I prefer, and will adopt for use in this paper, 
the word menopause. 

I need not tell you that the menopause usually occurs 
between the ages of forty and fifty, nor remind you of 
the frequency of its occurrence in women who are under 
forty or over fifty. The menopause is not attained in 
the same manner by all women. Two-thirds of all 
women skip one, two or more periods for a longer or 
shorter time prior to cessation. The remaining one-third 
are perfectly regular to the time of cessation, so that by 
far the larger proportion of women do not reach the 
menopause abruptly. They menstruate on alternate 
months or on every third or fourth month, or may men- 
struate for two months and skip one, two or three months 
for two, three or four years prior to final cessation. The 
average time for this larger class of two-thirds of all 
women who menstruate irregularly prior to cessation is 
two and one-half years. Some menstruate with interrup- 
tions for five, six or seven years prior to cessation, others 
for a few months only. 

A gradual shortening of the period of flow and a 
corresponding diminution of the amount is generally 



3l8 MEDICAL SOCIETY OF NEW JERSEY. 

observed in those who terminate abruptly. This feature 
of shortened menstrual periods and lessened flow is not 
so constant in the larger class who menstruate irregularly 
prior to final termination. Some who skip or dodge 
periods also flow more profusely than has been their 
custom, while they also have what is for them a slightly 
lengthened period of flow. To aid us in judgment of 
any particular case, as to what is physiological and what 
pathological, we must enquire particularly into the previ- 
ous habit of the woman, and when we find that the 
lengthened menstrual period and increased flow is mar- 
kedly out of proportion to her habit in the preceding- 
years, we will be warranted in the assumption of the 
co-existence of a pathological condition of some sort in 
her pelvic organs ; in other words, her case is not purely 
physiological. 

Dr. Tilt, in his work on the change of life, exhibits a 
large number of women with floodings at the close of 
menstrual life. Many of the cases which were then 
(forty years ago) considered as physiological would now 
be regarded as pathological. The presence of endome- 
tritis, small uterine myomata and the forthcoming of 
cancer, were doubtless the unknown pathological causes 
of many of the floodings which he and others of his 
time regarded as physiological. The profession and, 
indirectly, the public, still suffer from fixed and incorrect 
impressions regarding the menstrual function at the 
change of life, and we still dream of a train of symptoms 
and phenomena which occurred in one or other of the 
five hundred women examined by Dr. Tilt in relation to- 
the menopause, forgetting that many of the conditions 
enumerated just happened to individuals at that period,, 
and might have and doubtless did occur to numerous 
women long before and long after the menopause. 



APPENDIX TO THE MINUTES. 319 

Dr. Tilt named and enumerated twenty-nine diseases 
of the skin as occurring at the change of life. Some of 
these conditions, as " hot flushes " and ** perspirations,"^ 
are so common in connection with the menopause 
that their relation to it is incontestable; but what 
shall we say of falling off of the finger-nails in one case 
of his five hundred, of shingles in one case of the five 
hundred, of herpes-circinata in one case of the five 
hundred, of eczema in two cases of the five hundred, of 
cedema of the legs in sixteen cases of the five hundred^ 
of boils in three cases, of seven abscesses, and seven 
ulcerated legs? Had Dr. Tilt inquired as particularly 
into the history of another class of five hundred women 
at a period of their lives ten years before or ten years 
subsequent to the menopause, I doubt not that he might 
have recorded as many little skin affections as he reports 
for the period during which the menopause was being 
established. In other words, I believe that aside from the 
*' hot flushes," ** dry flushes ** and " perspirations," most of 
the other skin affections reported by him were mainly 
coincidents. Many believe that the more abruptly the 
menopause occurs the less marked and the less prolonged 
is the series of ** hot flushes," " dry flushes," " perspira* 
tions" and other disturbances of the nervous system. 

For want of time, I shall not dwell upon the derange- 
ments of the nervous system incident to the menopause^ 
more than to say that from a brief study of or reference, 
to the conclusions of Sutherland, Merson, Buckniel and 
Tuke, Rohe, Braxton Hicks, Kae, Grissinger, Skene, 
Currier and others, I am convinced that insanity, and 
especially melancholia, may result from the menopause. 
It is undoubtedly the exciting cause and often precipi- 
tates mental unbalance where heredity or predisposition 
exists. The development of painful menstruation or 



320 MEDICAL SOCIETY OF NEW JERSEY. 

pelvic pain in one who has not had such pain, should not 
be credited to the change of life. The development of 
leucorrhea at any period of life calls for an investigation 
and, if possible, a discovery of its cause. Many women 
who have had marked leucorrhea for many years come to 
regard it as natural, and are barely persuaded that it is 
either serious or necessary to be cured. The prompt and 
permanent relief, both from leucorrhea and excessive flow, 
afforded so many of these cases by one or more thorough 
curettings, furnishes indisputable proof that these women 
have a most chronic but possibly not dangerous patha- 
logical condition of their endometriums. 

The uterus is a pocket ; its cervix is a sinus, and when 
once well inoculated with pyogenic tubercle or gonococcio 
bacilli, it is common for the disease to extend itself to 
the fallopian tubes, producing more or less pelvic pain, 
backache, fever possibly and headache, affecting the 
health in a degree ; and yet neither the pelvic pains nor 
the physical disability may be sufficient to cause all who 
are so affected to apply to us for relief. 

Less than a year ago a widow, aged fifty-nine, who had 
been a widow for fifteen years, was referred to me by her 
physician for relief from endometritis and salpingitis. 
She complained of a thin discharge from the vagina, 
** burning waves all over her (using the patient's expres- 
sion) and pelvic pains, flushes and perspirations. She 
had ceased menstruating at forty-nine. The leucorrhea 
had begun eight years after the entire cessation of men- 
struation, and yet she thought it due to the ^change of 
life. With great reluctance she yielded her sexual 
history, and I soon established the existence of gonorrhoea 
as the cause of her pelvic symptoms. The patient's out- 
burst of indignation for an old " friend who could have 
been so untrue to her ** in their unlawful relations, was 



APPENDIX TO THE MINUTES. 321 

evidence that she had little, if any, suspicion that her 
pelvic trouble was other than a part of the menopause. 

If a patient is nearing the age when the menopause is 
expected, or if she has begun to skip her periods and 
develops a leucorrhea or an increase of a previously 
existing one, with or without pain, she is apt to regard it 
as a part of the change of life. She may consult her 
physician, who, coinciding with her views, encourages her 
to expect that the complaint will cease when the change 
of life is effected. He may advise a vaginal douche or 
other simple treatment and hear nothing further from her 
case for a year or two. The patient then returns to him 
and announces, perhaps, the fact that the leucorrhea has 
become more abundant and possibly, irritating ; that at 
times her clothing has been 'slightly blood stained, and 
possibly, odorous. He makes a physical vaginal exami- 
nation and may at once discover unmistakable evidence 
of carcinoma. He then realizes that the advice which he 
gave the patient a year or two before offered an assurance 
which a more careful consideration of her complaint 
would not have warranted him in bestowing upon her. 
The question of operation arises and he is confronted 
with a prognosis which has been made far more unfavor- 
able because of the neglect of her case for which he 
was mainly accountable. 

Such a picture reflects seriously upon the attendant 
and he begins to suffer for so easy and careless a consider- 
ation of her case. Sometimes the patient whose symp- 
toms have been so lightly regarded by her family 
physician, shortly consults another who enters into a 
particular examination of the case and thereby secures 
for her, treatment or operation at a stage when the 
promise of relief or permanent cure may be offered her in 
greater measure than would have been possible under 



322 MEDICAL SOCIETY OF NEW JERSEY. 

•circumstances of delay. Her careless and indifferent 
advisor's loss of a patient is her gain in good fortune. 

While the patient's own physician is sometimes care- 
less and his advice dangerous, it far more often happens 
that his interest in his patient and fear of carcinoma or 
tumor is aroused by the occurrence of hemorrhage or 
metrorrhagia, and that he at once forms an unfavorable 
prognosis in which the patient herself, for a time at least, 
has far less participation than he. He suggests that the 
symptoms which she presents are such as are altogether 
likely to lead to ill-health and later, possibly, to death 
if not soon cured by surgical art. She is impressed with 
the probably serious character of her disease and at once 
decides to do as her physician directs. In the little 
period of time which he gives her to prepare for opera- 
tion, or for futher consultation with another, she possibly 
<:ounsels with other women who form hasty conclusions 
from personal or other experience, and assure her that 
the occurrence of leucorrhea and a little blood at unusual 
times is quite common at the change of life, and that if 
they were she they would not give it serious con- 
sideration. 

Rapid and pronounced changes, as you know, either in 
the health or local conditions of the pelvic organs, is 
rather the exception in malignant disease, and conse- 
quently this patient, so cautiously and wisely advised by 
her own physician, soon belittles, if she does not ridicule, 
his advice, and, with the reassurance of her friends who 
know not that they know not, she goes on to a point 
where the local lesion and glandular infection become so 
pronounced that surgical art can be to her of little or no 
avail. She then appreciates for the first, and with awful 
emphasis, the wisdom of rejected professional advice and 
the magnitude of her folly. 



APPENDIX TO THE MINUTES. 323 

These two pictures, one representing the careless 
-medical advisor and the other portraying the dangers of 
faulty impressions which the laity have formed regarding 
the menopause, are repainted daily. Many of you 
doubtless recall such experiences. Cancer of the uterus 
:generally announces its coming by leucorrhea, inter-men- 
strual bleeding, post-catamenial bleeding or excessive 
menstrual flow. The popular and faulty impression of 
the laity regarding the menopause will deter many from 
even consulting their medical advisors until favorable 
time for surgical treatment has passed. Only recently a 
woman of about fifty, the wife of a farmer, was brought 
to me by her physician, to whom she had just then 
applied for relief from continuous and uninterrupted 
metrorrhagia of one year's standing. She had menstru- 
ated with entire regularity up to the time that the bleed- 
ing became almost continuous. It had been preceded by 
a more profuse leucorrhea than was usual with her, and 
yet, as she explained to me, she believed that she was 
undergoing the change of life. Her cancer had effaced 
the vaginal part of the cervex and had advanced on the 
anterior vaginal wall and within one inch and a half of 
the meatus urinarus. She bled for one year without con- 
sulting a physician, because she thought it was the 
-change of life. 

After carcinoma, the next and most important patho- 
logical condition affecting the character and quantity of 
the menstrual fluid, or giving rise to metrorrhagia, is the 
<ievelopment of fibroid or myomata of the uterus. Com- 
paratively small fibroids have been found to be sufficiently 
harmful to compromise, by the hemorrhage they occasion, 
the patient's health, and gradually produce emaciation 
and a color and appearance of the skin quite akin to 



324 MEDICAL SOCIETY OF NEW JERSEY. 

what is known as the cancerous cacexia. The very 
small percentage of deaths now following removal of 
myomata or fibroid, warrant us in the abandonment 
of the expectant or non-operative plan of treatment in 
all cases where the bleeding is excessive, the tumor 
cumbersome, painful, or causing injury or pressure upon 
other parts of the body. 

If, of the five hundred women examined by Tilt, one 
hundred and forty-six had leucorrhea, I should say, with- 
out regard to their social status, that a small percentage 
had acquired their leucorrhea from gonorrheal infection, 
and that all others had received it from septic infections^ 
local tuberculosis of the uterus or fallopian tubes, or from 
carcinoma, or a fibroid condition of the uterus. There 
is little in the change of life itself to effect serious 
or pronounced pathalogical conditions of the pelvic 
organs — the presence of cancer, fibroma and the pyogenic 
and gonorrheal diseases of the uterus and vagina are 
simply co-existent with the menopause and rarely result 
from it. If consulted by a woman between thirty and 
forty for any pelvic symptom, we should make a particu- 
lar inquiry into her history and supplement it with the 
usual physical examination. If another presents between 
the ages of forty and fifty, with pelvic symptoms, we 
should not allow ourselves to be prejudiced by her age 
and underestimate the importance of her complaint be- 
cause of its nearness to the menopause. There are 
almost as many women affected with pelvic disease 
between the ages of thirty and forty as from forty to- 
fifty, although at one period we find an excess of one 
class of affections and at the other, another class. The 
relative proportions are slightly different for the two 
periods. 

I wish to direct special attention to the importance of 



APPENDIX TO THE MINUTES. 325 

an early detection of cancer. The ease with which the 
uterus, or a portion of it, may be removed, and the 
gradual lowering mortality attending such operations, 
offers special reason for greater vigilance in this relation. 
It is true we can often safely extirpate the carcinomatous 
uterus when health, strength and vitality are almost ex- 
hausted, but the ultimate result to such patients, com- 
pared with that following the earlier operation, is so 
gloomy that he who operates late derives only a limited 
degree of satisfaction from his relation with such cases. 
If cancer is not recognized by the fingers or eye, and if 
the patient be over thirty or thirty-five and has leucorrhea, 
or menorrhagia or metrorrhagia, for which curetting is 
practiced, we should seek the aid of microscopical diagno- 
sis. Failure to find cancer cells will not disprove the 
possibility of its presence in any given case, and its dis- 
covery, together with gross appearances and the patient's 
history, will generally guide us to a proper course. Let 
us then remember that the menopause of itself has little, 
if any, effect in either precipitating or arresting the more 
serious diseases of the pelvic organs ; that many of the 
pathological conditions of the pelvis are inaugurated and 
maintained with little regard to that special period in the 
life of females when the phenomena of ovulation and 
menstruation are preparing for their final departure. 



21 



ESSAY. 



BY S. A. TWINCH, M.D., NEWARK. N. J. 



Early Diagnosis and Treatment of Pott's Disease. 

Spondilitis or Pott's disease is a chronic tubercular 

ostitis, which may begin in any part of the spinal column. 

In considering the symptoms of the 

disease, we will only mention those 

which aid us in diagnosis before angular 

deformity appears, because it is only 

during this period that any question as 

to the nature of the disease is likely 

to arise. In the great majority of cases, 

(taken early) perfect arrest of the disease 

may be effected, and all deformity pre- 
vented. Usually 
there is present 
a premonitory 
stage frequently 
unobserved, the 
which are included in the compre- 
hensive term malaise, a condition 
between vigorous health and sick- 
ness, a want of energy, an irrita- 
bility, a lowering of all the vital 
functions. 

The symptoms of the disease 
vary somewhat with the region of 
the spine affected. We will there- 
fore consider the cervical, dorsal. 

Fig. a.— Poll's Disease, sixth and 

seventh cenricai. and lumbar regions, separately. 





Fic. I.— Cervical Pott's 
Disease. (Sayre). 

symptoms of 



328 MEDICAL SOCIETY OF NEW JERSEY. 

Cervical Pott's Disease. The chief symptom of dis- 
ease in this region is due to the rigidity of the muscles 
around the neck, accompanied by difficulty in breathing 
and occipital neuralgia. The head is sometimes held in 
vety distorted positions, the most characteristic of which, 
perhaps, is where the head is to one side, neck bent 
forward, and face looking downward. In Figure 2 the 
neck is flexed so that the weight of the head is trans- 
mitted to the sternum on which the chin is resting. In 
another case, the head was resting on the shoulder with 
sufficient weight to cause an ulcer at the point of contact. 
The various positions which may be assumed, 
are maintained by the extreme rigidity of the 
cervical muscles ; the head being held so firmly 
that when the patient turns sideways to look 
at an object the body turns also. Difficulty 
in swallowing may also be present, caused by 
post-pharyngeal abscess, or angular deformity 
of the vertebrse. Therefore, a digital examina- 
tion of the throat should not be neglected. 
In disease of the first and second cervical ver- 
tebrae, there is a peculiarity in that they arc 
Ficj-in- ^ore comfortable while standing or sitting, 
"""oiBue"' than while lying down; in fact, they cannot be 
(lower doTHij. i^jy^gj J.Q jjg down. This is probably due to 
the anatomical construction of the vertebrae, the recum- 
bent position causing the atlas to press upon the odontoid 
process of the axis. In disease situated anywhere below 
the second vertebra the symptoms are relieved by the 
recumbent position. 

Cervical caries is frequently confounded with torticollis. 
In dilTerentiating the two, we know that in caries there is 
far more rigidity of the cervical muscles, with pain, especi- 
ally upon manipulation, situated either at the seat of the 



APPENDIX TO THE MINUTES. 



329 




disease, or along the course of nerves proceeding there- 
from. In caries, the spasmodic contraction is bilateral, 
and usually affecting all the muscles of the neck, while 
in torticollis only one muscle is affected. In caries below 

the second vertebra, the symp- 
toms are relieved by the recum- 
bent position ; not so in torticollis. 
In caries, rotation of the head is 
very painful. In torticollis, the 
head is rotated toward the af- 
fected side ; in caries, away from 
it. 

In dorsal caries, one of the 
earliest symptoms is an involun. 

tary rigidity of the muscles of 
r.o.4.-Heaithy Spine. ^j^^ j^^^,^^ ^f^^^ accompanicd by 

an undue prominence of the abdomen. This muscular 
rigidity is evidently nature's method of splinting the 
spine, and thus preventing friction of the diseased verte- 
brae one upon the other. 

The natural flexibility of the 
healthy spinal column, and the 
inflexibility of the diseased one, 
is very significant. This is well 
shown in the act of stooping. 
Instead of the graceful curve 
which the healthy spine assumes 
(Fig. 4), the diseased one is 
held perfectly still (Fig. 5). In 
attempting to stoop, the child with 
the diseased spine flexes only his 
knees and hips, and Anally squats 

down to pick up the object. The same condition is 
noticed in attempts to flex the spine in the backward 




Fig. 5.— Diaeaaed Spine. 



330 MEDICAL SOCIETY OF NEW JERSEY. 

direction, Fig. 6 being that of a healthy spine, and Fig. 7 
a diseased one. A peculiarity in the gait is another 
early symptom. The child walks with great care ; the 
knees are slightly flexed, so as not to transmit any jar to 
the spinal column. If the child takes a misstep, the jar 
causes pain. In stepping down from the sidewalk to 
the street, for instance, he goes very carefully, so as not 
to transmit any sudden motion to the seat of disease. 

Lateral deviation of the spinal column is also a well- 
known early symptom, and one on which a great deal of 
reliance can be placed. The curvature in some cases is 
slight, and so may be easily overlooked by a casual obser- 





Fig. 6.— Healthy Spine. Fig. 7. — Diseased Spine. 

vation. In illustrating this point please notice Fig- 
ures 8, 9, 10. The case shown in Fig. 8 has caries of 
the spine in its incipient stage. That in Fig. 9 is further 
advanced, so much so that the well marked curvature 
can be noticed at a glance, while the remaining case 
(Fig. 10), is much further advanced, having had the 
disease for several months. The spasm of the muscles 
is so great, that the upper part of the body is held to 
one side. Besides this, ihe dreaded deformity has com- 
menced by a knuckle, appearing on a level with the 



APPENDIX TO THE MINUTES. 



331 



inferior angles of the scapula, which, if allowed to go 
without treatment, will gradually but surely, develop into 
a well-marked humpback. 

Elevated temperature is a constant companion of 
tubercular trouble, and should not be overlooked in 
incipient Pott's disease. The rise occurs independently 
of the formation of pus, and cases with unopened abscesses 
frequently do not present a higher temperature, than 




those where no abscess can be detected. The afternoon 
rise is from one to four degrees, and in a general way, the 
rise is greater in the severer cases. Paroxysmal pain is 
also a frequent symptom. It may be at the seat of the 
disease, in the chest or abdomen ; it may be aggravated 
by jarring, or movement, or coming on at night, causing 
the child to cry out, and thus simulating very closely the 
night cries of hip disease. The abdominal pains are 
frequently mistaken for indigestion, with stomachache. 



332 



MEDICAL SOCIETY OF NEW JERSEY. 



The occurrence of persistent abdominal pain in a child 
ought to receive more attention than it freqently does. 
Although it is in no way diag- 
nostic of Pott's disease, yet it 
is so frequently associated with 
it that a very careful examina- X^^^^L^^ 
tion should be made of the ' 
child, stripped of all clothing, 
so as not to overlook the dis- 
ease in its early stages. On the 
other hand, the absence of pain 
can in no way be assumed to 
prove the absence of Pott's 
disease. 

Other symptoms which 
should arouse suspicion are tir- 
ing easily, leaning on chairs 
and tables, and supporting the 
weight of the trunk by the 

arms. 




Fic XX.— Characteristic poddon in 
Pott's Disease (Sayre). 




Grunting is also a prominent and 
very common symptom, especially 
when the disease is in the dorsal region. 
Dorsal Pott's disease must be differen- 
tiated from rachitic, and rotary lateral 
curvature of the spine. In rachitic 
curvature of the spine, we have one or 
more of the rachitic symptoms, viz., 
the enlarged epiphyses, the open fon- 
tanel, decayed teeth, beaded ribs, large 
head, etc. In rotary lateral curvature 
there is no spasm of the muscles; there 
is less pain, perhaps no pain ; the rotary element is more 
prominent and there is no elevation of temperature. 



Fig. xa. — Rachitic 
Curvature. 



APPENDIX TO THE MINUTES. 



333 



Lumbar Pott's disease is more difficult of detection 
in its early stages, due, to a great extent, to the protected 
position the vertebrae occupy in this 
region. Owing to the anterior curve 
which the lumbar spine takes, there 
may be no posterior deformity, until 
very considerable destruction of bone 
has taken place. The occurrence of 
deformity is preceded by flattening of 
the lumbar curve, which is very sig- 
nificant. The attitude is that of 
lordosis, the gait is military and careful. 
Lateral deviation of the spine is always 
present, sometimes in a very marked 
degree. It is in this region of the 
spine that lateral curvature is most 




Fig. 13.— spinal curvature 

in Lumbar Pott's Disease. 

(Sayre). 



conspicuous as a symptom. 

In using the ordinary tests to 
detect the disease, one is liable 
to be deceived by the readiness 
with which some children can 
bend the spine in picking up 
objects from the floor. Lumbar 
Pott's disease must be differen- 
tiated from hip-joint disease, 
and lateral curvature already 
mentioned. In Pott's disease 
the irritation of the lumbar 
nerves frequently causes psoas 
contraction and drawing up of 
the thigh, so characteristic of 
hip disease. In the early stages 
it is extremely difficult to differentiate between the two 
troubles, but in general, when the hip symptoms are due 




Fig. i4.~Psoas Contraction in 
Lumbar Pott's Disease, 
simulating Hip 



334 



MEDICAL SOCIETY OF NEW JERSEY. 



to Pott's disease, and the joint symptoms are caused by 
psoas irritability, the restriction of motion in the hip is 
simply in the loss of extension, while abduction and 
internal rotation are free and not affected. This limita- 
tion of motion in only one direction is usually sufficient^ 
in connection with other symptoms, to establish the 
presence of Pott's disease. 



COMPLICATIONS. 

Abscess, The majority of cases where treatment is 
commenced early run through the entire course of the 
disease, and recover without any formation of abscess; 
but in those cases where there is considerable destruction 
of bone, the appearance of one or 
more abscesses is probable, and is 
nearly always due to inefficient or 
incomplete treatment. The location 
of an abscess and the point of open- 
ing varies with the location of the 
disease. In cervical Pott's disease, 
it usually opens into the mouth or 
neck. In dorsal or lumbar disease 
it may make its appearance in the ^'''' "'"^^l^^, ^^"^^ 
back, or burrow so as to open below 

Poupart's ligament, or further down the thigh. It is very 
essential during the treatment to watch patients carefully^ 
and be sure that their spines are properly supported, so that 
all superincumbent weight is removed from the diseased 
vertebrae, and thus prevent this unpleasant complication. 




TREATMENT. 



In instituting treatment we must not forget that this 
is a tubercular trouble, and therefore calls for the consti- 
tutional and therapeutic measures usually found bene- 



APPENDIX TO THE MINUTES. 



335 



ficial in other manifestations of tuberculous disease. It is 
a local affection of certain 'bones and joints of the spine, 
which require to be put at rest. To fulfill this indication 
we must remove superincumbent weight, and prevent 
friction of the diseased surfaces one upon the other. 
The two kinds of appliances used for this purpose are 
the plaster of Paris jacket, 'and the spinal brace made of 
steel. Each of these have their advocates, who seem to 
base their conclusions on the failure of one, rather than a 
careful comparison of the respective merits of each. 

Both of these have their use, and we 
will endeavor to point out what 
are the indications for each respec- 
tively. First, let us consider plaster 
of Paris, as the most suitable of all 
material to make jackets. It has 
the advantage of being cheap, and 
can be moulded to fit the body 
accurately. It is also porous, as can 
be shown by a simple demonstration. 
Plaster jackets should be renewed at 
least every three months. These 
jackets are especially suitable for 
mid-dorsal, lower dorsal, and lumbar 
Pott's disease. Whenever the disease 
is above the lower dorsal region a 
jury-mast should be used to support the weight of the 
head and shoulders. 

Every jacket should be made to fit the body accurately 
and snugly. To do this, it must not be furnished with 
buckles and straps, containing a number of holes, so that 
it can be loosened and tightened at the will of the 
patient. If there is to be any fastening, a single row of 
hooks, such as are used on laced shoes, are the best, and 




Fig. 1 6. — Brace for Cervical 
Pott's Disease. 



336 



MEDICAL SOCIETY OF NEW JERSEY. 



then care must be taken, when lacing it, to bring the 
edges together so as to make it perfectly firm. There is 
an advantage in the solid plaster of Paris jacket, that 
when it is once applied, it cannot be tampered with by 
the patient. In regard to the preference between the 
laced and the closed jackets, our usual practice is, to keep 
a child in a closed jacket for about three years, then let 
him wear the open or laced jacket for another year, 
the last six months of which time he leaves the jacket 
off at night. 

For upper dorsal and cervical disease, the plaster jacket 
is unsuitable, because it does not give support above the 
diseased point. The only service a jacket 
can render in these cases is to form a base 
or support for a jury-mast. A very good 
apparatus for the cases in question is 
shown in Fig. i6. It is a combination of 
Sayre's body brace and Schafifer's head 
piece. This apparatus immobilizes as well 
as supports the weight of the head, and 
therefore is far superior to the jacket with 
a jury-mast. 

The foundation of all jackets and spinal 
braces is the hip bones. It is therefore 
useless to apply a jacket or spinal brace 
of any kind until this part of the child's 
anatomy is sufficiently developed to give 
the desired support. This seldom takes 
place until the age of three has been reached. Prior to 
this time we have to devise some other mode of treat- 
ment. The only satisfactory way of treating these very 
young children is by recumbency, for which can be used 
the wire cuirass. For cheap clinical purposes a board 
can be cut to the shape of the child, and then well padded, 




Fig. 17. — Dorsal 

Pott's Disease, 

treated by 

recumbency. 



APPENDIX TO THE MINUTES. 337 

SO as to make it comfortable for him to lie on. If 
traction is required, a jury-mast*head piece can be applied 
to the upper end of the board. The child is then band- 
aged to the board, being partially removed morning and 
evening, so that the back may be rubbed with alcohol, 
and dusted with powder to prevent irritation, especially, 
in warm weather. 

Whatever treatment may be selected by the surgeon, 
as the most suited for the particular case in question, it 
is very important that a proper and concise record be 
kept, that the deformity, if any, does not increase. The 
little knuckle in the back which may be very small at first, 
may increase so gradually, that we hardly notice any 
change until it has reached a comparatively large size. 
For this purpose a photograph is useful, but better still, 
a tracing taken with a flexible piece of zinc, and the shape 
cut out in pasteboard for future reference. As soon as 
we find our case is beginning to increase in deformity, no 
matter how slight this increase may be, we should look 
at once for the cause. There may be some fault in the 
apparatus, so that it does not give suflficient support to 
the spine, or the child may be doing too much running 
around, or, for this particular case, recumbency may be 
indicated for a few weeks. Whatever the cause is, it 
should be sought for and removed if possible. 

For bed patients with Pott's disease, it is advisable to 
use some apparatus to ensure the child being kept con- 
stantly in the recumbent position. The Bradford frame 
is extremely simple, yet answers all purposes. It is made 
of four pieces of gas pipe, put together with round elbows. 
Across this frame is stretched two pieces of canvas, between 
which a space is left opposite the buttocks. This frame 
can be laid on the bed and the child strapped to it. It can 
be carried from one part of the house to the other with- 
out disturbing the child in any way. 



338 MEDICAL SOCIETY OF NEW JERSEY. 

Abscess, The treatment of abscess depends on its loca- 
tion. Post-pharyngeal abscess should be opened as soon as 
possible, because of its tendency to embarrass respiration. 
Abscesses in other locations are better let alone, except 
when there is a great deal of systemic disturbance, or 
when it is increasing so rapidly, that it will open itself un- 
less interfered with. If opening seems imperative, after 
evacuation, the wound should be dressed antisepti- 
cally, and kept very clean. Injection of iodoform and 
glycerine, or other mixtures in these cases, is of little use, 
as there is small possibility of being able to reach the 
seat of disease. The formation of an abscess, however, 
in a case which has been under treatment for some time, 
suggests that the spine is not being fully and properly 
supported. The case may need a jury-mast, or, possibly, 
ambulatory treatment is contra-indicated for the time 
being. If such be the case, a few weeks in bed wearing 
the apparatus will be of inestimable service. 



ESSAY. 



BY FRED'K R. bailey, M.D., ELIZABETH, N. J. 



Recent Advances in the Normal and Patho- 
logical Histology of the Central 
Nervous System.* 

Should some neurological Rip Van Winkle awake to- 
day after his twenty years of oblivion, and should he find 
his way into one of our larger medical libraries, and have 
there placed before him any of the more recent works 
upon his favorite subject, he would stand no less amazed 
than did the real ** Rip," when, after his long sleep, he 
found himself once more in his native village. He would 
look in vain for the faces of the once familiar words and 
he would put his hands to his head in bewilderment at 
the new and unknown terms, in a few of which he might 
recognize some faint lines of resemblance to past friends. 
And if he is an astute observer he realizes that the science 
of neurology has made tremendous strides in those past 
twenty years, for each new name but indicates some new 
thought, the genesis of the term but succeeds the genesis 
of the idea. 

The history of the advances which have marked the 
evolution of our knowledge in all those branches of 
medical science which necessitate the use of the micro- 
scope, is the history of advances in operative technique. 
In histology, in pathology, in bacteriology, each new era 
of progress has been but the successor to some new 
method of investigation. Par excellence may this be 



•Fellows' Prize Essay of the Medical Society of New Jersey for 1898. 



340 MEDICAL SOCIETY OF NEW JERSEY. 

said of the development of our knowledge of the his- 
tology and the patholgy of the nervous system. Each 
new discovery in neurological technique has opened up 
new paths of investigation and has invariably led forward 
to important progress in knowledge. The climax of 
investigation along the lines of a given method is reached 
and research is on the wane, when some new ** way " is 
announced and the whole neurological world is again in 
a bustle of activity to carry to exhaustion the possibilities 
of this new method of work. 

Aside from those discoveries in general operative tech- 
nique which mark epochs of advance in histology and its 
allied sciences — such discoveries as fixation and hardening 
of tissues, staining, section-cutting, etc. — three discoveries 
in method mark three distinct eras in the development of 
our knowledge of the architecture of the central nervous 
system. 

1. The method of Weigert. This may be called the 
** nerve fibre method." It stains only the medullary 
sheath, and therefore differentiates the medullated nerve 
fibres only. Following the discovery of the method of 
Weigert came a long line of valuable investigations upon 
the courses of the various fibre tracts of the brain and 
cord. As, however, the fibre leaves the cell in a non- 
meduUated condition, this method gave no insight into 
the relations existing between the nerve fibre and the 
nerve cell ; nor did it give any indication of the minute 
structure of the nerve cell. 

2. The method of Golgi. As the method of Weigert 
is the nerve fibre method, so the method of Golgi is the 
** nerve cell method." It stains homogeneously the nerve 
cell in toto, that is, the nerve cell and all its processes up 
to the point of acquisition of a medullary sheath, beyond 
which point it does not stain. This method gives us> 



APPENDIX TO THE MINUTES. 34 1 

as it were, a neuron " silhouette." It pictures the entire 
nervous system as made up of a great number of super- 
imposed units. These units or nervous elements are 
seen to be anatomically independent of one another, 
each unit constituting a complete nervous mechanism 
capable of receiving a nervous impulse, of acting upon it 
and of transmitting it. 

The technique of the method of Golgi is extremely 
simple. It consists in, first, hardening in a solution of 
potassium bichromate; second, transferring to a solotront 
of silver nitrate ; third, embedding, sectioning and mount- 
ing as usual. Treated by this method, the nerve cells: 
present a striking picture. The cell body appears jet: 
black by transmitted light and shows no evidence of any 
internal structure. Passing off from the cell body proper 
are seen innumerable branches crossings and interlacing 
with one another but never anastomosing. These are 
known as the protoplasmic processes ; are stained like a 
cell body, black, and are seen to be studded with little 
excrescences having knobbed ends and known as ** gem- 
mules.*' These protoplasmic processes divide and sub- 
divide, becoming rapidly smaller as a result. From some 
part of the cell body or from one of the larger proto- 
plasmic processes, a process of a quite different nature 
is seen to pass off. This is rather straight, sends off but 
few branches, these few at right angles and not percep- 
tibly diminishing the diameter of the process. This is^ 
known as the axis-cylinder process and is destined to* 
become the axis cylinder of a nerve fibre. By this 
method are also stained the cells and fibres of the type oi 
connective tissues peculiar to the nervous system, the 
neuroglia. 

As a result of investigations upon the structure of the 
central nervous system by means of the method of Golgi,, 

29 



342 MEDICAL SOCIETY OF NEW JERSEY. 

certain facts of extreme importance have been ascer- 
tained. These are : 

First. That the nerve cell and the nerve fibre are not, as 
we had so long believed, two separate elements in the 
structure of the nervous system ; that no nerve fibre 
exists that is anything other than an outstretched arm, 
as it were, of a nerve cell, and, conversely, that there is 
no nerve cell but is continuous by one of its prolonga- 
tions with a nerve fibre; that if, applying the same 
method, we look to embryology for light on the subject, 
it shows us that the nerve fibre Is developed as an out- 
growth of the protoplasm of the cell body; that the 
process of the nerve cell with which the nerve fibre is 
continuous, is always the axis cylinder process. This 
process is physiologically centrifugal in character, that is. 
It carries impulses ovXy from the cell. 

Second. That* in addition to the axis cylinder process, 
the nerve cell possesses numerous other processes of 
different nature, both as regards stiucture and function. 
These are known as protoplasmic processes and are 
centripetal in character ; that is, they transmit impulses 
to the cell body. They are what might be called the 
"sense organs" and represent its receptive apparatus, 
bringing it in touch with the terminal arborizations of the 
processes of other cells. 

Third. That the nerve cell, with all its processes — this 
" neuron," as it is called — is a distinct and separate 
nervous entity, a complete unit in itself, and unconnected 
by continuity with any other nervous element. It follows 
directly from this, that the passage of a nervous impulse 
from one nerve cell to another must take place either 
through contact or, more likely, through mere contiguity 
of the nervous elements concerned. 

Fourth. That the nervous system as an organ is made 



APPENDIX TO THE MINUTES. 343 

up upon the same general plan of architecture as the 
other organs of the body. The neuron represents the 
parenchyma cell of the different parts of the nervous 
system considered as organs, and from both anatomical 
and functional standpoints. The neuron of the brain, 
for example, holds exactly the same relation to the brain 
as an organ, as does the parenchyma cell of the liver, to 
the liver as an organ. In each case it is the anatomical, 
the functional unit, that by virtue of which brain is brain 
and liver is liver, and in each case the parenchyma cells 
are supported by a connective tissue framework, modified, 
it is true, in the case of the nervous system ; differentiated 
both morphologically and embryologically from that 
found in the other organs of the body, and yet a real 
supporting connective tissue. 

3. The value of such a method of technique, to 
which we owe such fundamental facts as those enumer- 
ated, cannot be over-estimated. But valuable as were 
the methods of Weigert and of Golgi, and far-reaching as 
were their effects upon our knowledge of the structure of 
the nervous system, they gave us absolutely no insight 
into the minute structure of the ganglion cell. It was 
not until Nissl announced a method of differential stain- 
ing of the contents of the cell body, that any advance 
was made in our knowledge of neurological cytology. 
When we consider in what a rudimentary state our know- 
ledge of the ultimate structure of the nervous system 
really is, and especially how little we know of the physio- 
logical significance of our anatomical data, how little more 
we actually comprehend when we speak of the origin 
and transmission of a nervous ** impulse " than did Ren^ 
Descartes three centuries ago, when he spoke of " animal 
spirits," we appreciate the attractiveness of a method 
which reveals the ultimate structure of the cell body and 



344 MEDICAL SOCIETY OF NEW JERSEY. 

offers some hope of solution of the vexed questions 
which constitute the "metaphysics," as it were, of 
neurolog}'. 

Briefly stated, the technique of the method of Nissl 
is as follows: i. Tissue, fresh as possible, is placed in 
a quick fixative, such as absolute alcohol or such mixtures 
as those of Lang and Van Gehuchten ; 2. Hardened in 
absolute alcohol ; 3. Embedded and cut in usual way ; 
4. Sections stained in solution of methylene blue; 5. 
Sections decolorized in alcohol containing anilin oil ; 6* 
Cleared and mounted as usual. 

Subjected to this method of technique we observe that 
the cells of the nervous system present two widely differ- 
ent types of reaction. First, certain cells stain only as to 
their nuclei, the cell body remaining perfectly clear. 
Such cells are those found in the olfactory lobe, the 
cerebellum, the retina, forming the so- call granule layers. 
To these cells Nissl has given the name caryochromes. 
As only the nucleus stains it is evident that nothing will 
be learned by the application of the method of Nissl to 
these cells, except as to their nuclei. Second, the vast 
majority of nerve cells, however, react, both as to their 
nuclei and as to their cell bodies, to the methylene blue 
stain. To these cells Nissl has given the name somat- 
ochromes. As the somatochromes alone react as to 
their cell bodies to the method of Nissl, it is these 
somatrochrome cells which acquire an interest when 
studied by this method of technique. 

If we take as an example of a cell of this type, one of 
the large ganglion cells of the ventral horn of the spinal 
cord, and pass it through the technique of Nissl, we 
observe the following structure : 

1. A nucleolus which stains an intense blue. 

2. An intra-nuclear network or nucleo reticulum ; 



APPENDIX TO THE MINUTES. 345 

usually retains a faint blue color but is easily decolor- 
ized and then restains readily with a basic dye like eosin. 

3. A clear ground substance or nucleo-plasm, unstained. 

4. A nuclear membrane which stains like recticulum. 

5. A cell network or cyto-recticulum, faintly colored 
and, in specimens not specially prepared, obscured by 
the more deeply stained elements of the cell body. This 
recticulum is present throughout the cell and extends, 
as fine striations, into the cell processes. 

6. Deep-blue-staining bodies of various shapes and 
sizes scattered through the cyto-reticulum and known as 
chromophilic bodies. 

7. A basement substance which is achromatic. 

It is this stainable substance, these so-called chromo- 
philic bodies, which are of special interest when studied 
by the method of Nissl. They present various forms ; 
are deposited in larger or smaller masses ; are regular or 
irregular in shape ; may be triangular or elongated rods ; 
may be arranged in rows or without any apparent order ; 
may be close together or quite separated. Sometimes 
we find a large mass of chromophilic substance, as the 
'' capuchon nucleaire " or nucleair cap, or again, as the 
** cone de bifurcation " or triangle of division, as is called 
the triangular-shaped body which marks the early bifurca- 
tion of the protoplasmic process. One part of the cell is 
always free from chromatic substance. It is the area 
adjacent to the axis cylinder process and called the 
^* axon hill." The manner of disposition of the chromo- 
philic bodies furnished to Nissl a method of classification. 

Having separated off the cells staining only as to their 
nuclei as caryochromes, he subdivides his somatochromes 
as follows: 

I. Arkyochromes, or cells in which the chromatic sub- 
stance arranges itself in rows or chains. 



346 MEDICAL SOCIETY OF NEW JERSEY. 

2. Stichochromes, or cells in which there is a more or 
less regular distribution of the chromophilic bodies 
throughout the cell body 

3. Gryochomes, or cells in which the coloring matter 
appears as fine granules. 

4. Arkyo-stichochromes, or cells in which a combina- 
tion of the preceding is present. 

At the time this classification was announced by Nissl, 
it was with the expectation that each morphological type 
of cell would correspond to a physiological type. Subse- 
quent observations, however, have failed to confirm this 
theory. Such, then, being the appearance of certain cells 
of the nervous system when treated by the method of 
Nissl, what significance are we warranted in attaching to 
this appearance? 

Cajal, Held and Van Leuhossek, working upon the 
nature of the chromatin, came to the same conclusion, 
namely, that all chromophilic bodies, however homogene- 
ous in appearance, were really granular in character. Held 
and Dujal, following up the idea suggested, examined 
fresh specimens in a passive medium, and discovered that 
chromophilic bodies as such, do not exist in such speci- 
mens, and, therefore, not in the living cell. The living 
cell possesses a slightly alkaline reaction. This reaction 
changes to acid within a very few minutes after death. 
This change in reaction undoubtedly has considerable 
effect upon the albuminoid elements of the cell. That the 
discovery of the non-existence of chromophilic bodies in the 
living cell vitiates the discoveries of Nissl, however, is far 
from the truth. To be sure, there exist in the living cell no 
distinct bodies which when dead and stained give rise to 
the Nissl picture, but it is, nevertheless so, that there does 
exist in the living cell some substance, a part of the cell 
protoplasm, which, when treated by certain fixatives and 



APPENDIX TO THE MINUTES. 347 

stained by certain dyes, gives rise to the appearance seen 
in the Nissl preparations. That this is in the nature of 
a precipitat;Jon, is probably true. 

That cells from different parts of the nervous systenn, 
of different sizes and shapes and functions, should react 
in different manners to the same method, far from 
being a strange phenomenon, is what chemistry would 
lead us to expect. What we see in a nerve cell treated 
by the method of Nissl is an artifact, and yet it is an 
artifact which is always the same for a given cell and 
which is a real measure of the condition of the living cell. 

My own investigations by the use of the method of 
Nissl, upon the nerve cells of the central nervous system 
in the rabbit and in the guinea pig, have only confirmed 
an opinion I had previously formed, that in the present 
state of our knowledge on the subject, we can safely 
say this and no more : that, given a definite and satis- 
factory technique, a given nerve cell will always present 
the same reaction when subjected to that technique ; 
that in comparing one cell with another, and especially in 
comparing cells presumed to be pathological with cells 
presumed to be normal, the two sets of cells must have 
passed through exactly the same technique. 

Such being the appearance presented by a ganglion cell 
when subjected to the Nissl technique, and such being 
the conditions of its application, what is the probable 
physiological interpretation of the picture ? 

I. That the nucleus of a nerve cell differs in no essen- 
tial from the nucleus of other cells, either as to structure 
or as to function. It seems to preside over the construct- 
ive metabolism of the cell, to be the chief controlling 
agent in the transformation of the food products brought 
to the cell by the lymph, into the food elements of the 
cell itself, and their further elaboration from fcod 



348 MEDICAL SOCIETY OF NEW JERSEY. 

elements of the cells to form the nervous elements. In 
other words, the conversion of potential into kinetic 
energy. 

2. That the cyto-recticulum or cell network represents 
the working mechanism of the cell. It alone is concerned 
in the reception, transformation and emission of nervous 
impulses, and its condition determines the capability of 
the neuron in its nervous capacity. Thus, let us imagine 
a nerve cell stained by the method of Golgi and then 
the same cell stained by the method of Nissl, and super- 
imposed. The resulting picture will show this cyto- 
reticulum extending far out into the protoplasmic pro- 
cesses, even into the granules themselves. It is believed 
to possess, in this connection, both conductive and 
contractile powers. Thus, while serving to place every 
remote part of the neuron in direct touch with every other 
part, and allowing of the tr^nsmission to the centre of the 
neuron of any message received at any point in its 
periphery, it also serves as the retractive element for 
those same parts. Thus, for example, can a cell deter- 
mine the extent of its contact with other cells, if in a 
condition of fatigue it can retract its gemmules, thus 
throwing itself out of circuit, as it were, and allow itself 
time for recuperation. Just how far, upon this theory as 
a basis, we can explain such phenomena as sleep, as 
hypnosis, as coma, or, on the side of excitation, the phen- 
omena of hysteria, of delirium, etc., is as yet undeter- 
mined. If the passage of an impulse 'from one cell to 
another depends upon the contact or close approxima- 
tion of its peripheral endings, we can very easily see how 
the separation of these endings can impede or even pro- 
hibit the passage of such impulse. 

3» That the cyto-lymph is the food element of the cell, 
bat'.iing the cytoreticulum on all sides and acting as a 



APPENDIX TO THE MINUTES. 349 

reservoir of potential energy for its replenishing, the 
cytoplasm itself being constantly reinforced by an elabor- 
ation of the food elements brought to it by the blood 
through the lymph channels. That this cyto-lymph can 
be sub-divided into two constituent elements — a coarser 
food product which, when precipitated after death, is 
stainable as the chromophilic bodies, and a more refined 
food product, the direct food of the cyto-reticulum — is a 
theory that has recently been advanced. As lending 
support to this theory is the absence of the chromatic 
substance in the probable region of the most delicate 
functional activity, i, ^., that surrounding the exit of the 
axis-cylinder. Such may be the case. In the light of 
our present knowledge, however, it would appear that 
such refinement in description is rather in advance of our 
knowledge of facts. 

But if the new methods of technique have caused a 
revolution in our ideas of the structure of the normal 
nervous system, they have caused no less sweeping modi- 
fications in our views of the changes produced in that 
system as a result of disease processes. The method of 
Golgi, on account of its unreliability and lack of 
uniformity of reaction, combined with the fact that this 
method shows only the neuron as a whole, and that 
lesions, the most important, are often evidenced only by 
changes within the cell, has had a very limited usefulness 
in neuro-pathology. The method of Nissl, on the other 
hand, giving as it does a deep insight into the structure 
and condition of the cell protoplasm, is eminently fitted 
for the study of changes, even the most delicate, which 
are brought about as the result of disease. 

At the time of the introduction of the method of Nissl, 
the nervous system had a distinct and fairly well in- 
vestigated normal and pathological histology of its own. 



3 so MEDICAL SOCIETY OF NEW JERSEY. 

It appeared to be, as it were, a region apart by itself, of 
different structure and of different reaction to disease 
processes from the rest of the body. The differences in 
terms used sufficiently evidence this fact. The early 
results of research by means of the Nissl technique 
only added new terms and increased the confusion. 
Further research, however, by the use of the same 
method has resulted in the simplification not only of the 
results of previous work with the new technique, but also 
of the results of all the earlier work by means of older 
methods. A complete revision, marked by increased 
simplicity and unity, has taken place in the classic ideas 
as to the normal and pathological histology of the nervous 
system. That this is true as regards the normal histology 
of the nervous system, has already been shown in the 
description given earlier in the paper of the analogy of 
architecture of the brain and spinal cord to that of the 
other organs of the body. Turning now to pathology, 
let us see in how far we can make the terms with which 
we are accustomed to describe lesions in other parts of 
the body, serve the same purpose in describing lesions 
of the nervous system. 

First, — Parenchymatous degeneration or acute degener- 
ation of the nerve cell. If we examine the nerve cells 
of the cerebral cortex in a case of acute alcoholism, say 
in a case of death from delirium tremens, we at once 
notice that certain modifications have occurred in the 
appearance of the ganglion cells, and that these modifica- 
tions are of such a nature as to affect the character of the 
precipitation of the cyto-lymph. It no longer comes 
down as well defined granular masses, leaving the re- 
mainder of the cell perfectly clear, nor are the masses of 
staining substance as numerous as in the normal cell. 
The chromophilic bodies are seen to be broken up, to be 



APPENDIX TO THE MINUTES. 35 1 

smaller and less clearly defined, and to be fewer in num- 
ber. The background against which these lie is not clear 
as in the normal cell, but retains sufficient chromatin to 
enable it to take more or less of the blue stain. 

If we examine the cells of Purkinje, from the same 
case, or the motor cells of the anterior horn of the cord^ 
we see that, allowing for the inherent differences in 
cells from different localities; essentially the same con- 
dition is present in all the pathological cells. Not all 
the cells are in the same stage of degeneration. A 
careful study of the specimens shows cells in all stages 
of chromatolysis, as the destructive change in the chro- 
matic element of the cyto-lymph is called. Here and 
there are found cells to all appearances perfectly normal. 
From this, all grades of modification of the cytoplasm 
are observed up to complete destruction of the cell. 

These degenerative changes in the nerve cell have 
been found, not only in acute alcoholism, but in a large 
number of other diseases. These diseases fall into three 
general classes : 

1. Auto-intoxications; such, for example, as 

{a) The various uraemic conditions, including ec- 
lampsia, {d) Diabetes, (c) Sunstroke. 

2. External poisons; such, for example, as 
{a) Acute alcoholism. 

3. Infectious diseases; such, for example, as 

{a) Typhoid, {d) Pneumonia, in fact, the entire list 
of infectious diseases. 
This lesion we have already characterized as parenchy- 
matous degeneration. It is seen to occur in those dis- 
eases in which we expect to find degenerative changes in 
the other organs of the body. It is, in all probability, in 
no way different from those degenerations. The essen- 
tial nature is the same in all, its appearance modified 



352 MEDICAL SOCIETY OF NEW JERSEY. 

only by the kind of cell in which it occurs. Remember- 
ing now our physiological explanation of the normal 
appearance of the ganglion cell when treated by the 
method of Nissl, what insight can we get into the nature 
•of this degeneration ? 

The nerve cell, like the other cells of the body, receives 
-its nourishment from the blood through the lymph. 
'Each nerve cell is surrounded by a lymph space. From 
this lymph the food elements which the cell requires are 
taken directly into the body of the cell. A further 
elaboration to fit them for use as food for the nervous 
:mechanism of the cell, results, as has already been said, 
in the so-called cyto-lymph, from the constituent elements 
oi which the chromophilic bodies are precipitatedv Any 
•change, therefore, in the quantity or quality of the lymph 
would be evidenced by changes in the quantity or 
'quality of the cyto-lymph, and such changes in the cyto- 
lymph would naturally be expected to show themselves 
tn the resulting precipitate, namely, in the chromophilic 
bodies. 

The diseases in which we find these already described 
modifications in the precipitation of the cyto-lymph, are 
5uch as would be expected to produce changes in the 
character of the blood and lymph. They are diseases in 
which we find degenerative changes in nearly all the 
•other organs of the body. This, then, is the at present 
accepted explanation of the changes in acute degenera- 
tion of the nerve cell, or speaking of the different parts 
of the nervous system as organs, in acute parenchymatous 
degeneration of those organs ; a change in the character 
of the food elements of the cell, brought about by a 
•change in the character of the cyto-lymph, caused by the 
action of the disease. 

That these changes in the food elements of the cell 



APPENDIX TO THE MINUTES. 353: 

soon produce changes in the cyto-reticulum or true nerv- 
ous elements of the cell, is undoubtedly true. The nerve 
cell is the most highly differentiated cell in the body, and. 
the higher in organization the cell, the more immediately 
dependent is that cell upon its source of nourishment.. 
Thus, the nerve cell depends, not hour by hour, but 
almost minute by minute, upon the surrounding lympL 
for its food supply. The cell has work to do ; there is a 
dissipation of energy. There is, then, a very delicate- 
equilibrium existing between food supply on the one 
hand and expenditure of energy on the other, and any 
factor which tends to disturb this equilibrium immediately 
affects the functionating powers of the cell. The method 
of Nissl enables us to examine the condition of the 
cyto-lymph, but there is as yet no satisfactory method, 
for minute examination of changes in the cyto-reticulum. 
There is, undoubtedly, some point in this degenerative 
process which, when reached, completely inhibits the 
activity of the cell. There is likewise a point beyond 
which, if a cell degenerates, the ability of the cell ta 
return to normal is lost. The present state of our know- 
ledge does not enable us to say just what appearance of 
the cell indicates that such point has been reached,, 
almost complete chromatolysis seemingly being some- 
times compatible with a very considerable degree of 
functional activity. Until some new method of examin- 
ing the cyto-reticulum is discovered, these and similar 
questions appear destined to remain unsolved. 

There is a form of parenchymatous degeneration which 
has been described as peculiar to lesions especially affect- 
ing the axis cylinder, such, for example, as peripheral 
neuritis. The peculiar characteristics of this degenera- 
tion are as follows : {a) A diffuse blue stain throughout the 
cell, with an absence of chromophilic bodies in its central 



354 MEDICAL SOCIETY OF NEW JERSEY. 

area ; central chromatolysis, as it is called. (J?) A peripheral 
arrangement of the remaining chromophilic bodies, (r) 
Eccentricity of the nucleus ; the nucleus which in a normal 
cell lies, almost without exception, in the centre of the 
cell, having migrated so as to assume a position near or 
at the periphery. That migration of the nucleus is a 
phenomenon associated with starvation of the cell, has 
been shown for the lower forms of animal and vegetable 
cells. Just what change in food supply determines this 
eccentricity of the nucleus has not yet been ascertained. 
That it is a special modification and does not occur in all 
changes in cell nutrition, is proved by its occurrence in 
this form of degeneration of the nerve cell, while not 
occurring in the more common type previously described. 

Viewing it in this light, peripheral neuritis is primarily 
a disease affecting the food supply of the ganglion cell 
of the anterior horn of the spinal cord, and this being 
the case, the parts of the neuron first affected are those 
parts most remote from the sources of supply, i ^., the 
peripheral nerves. Experimental section of the peri- 
pheral ends of neurons produces similar changes in the 
ganglion cell. This would mean that this type of de- 
generation follows loss of function of the axis cylinder, 
** axon degeneration *' as it is called. The converse, that 
every cell presenting this type of degeneration is a cell 
the axis-cylinder of which has ceased to functionate, is as 
yet not established. 

Second. — Acute Exudative Inflammation. If we ex- 
amine the pons, the medulla oblongata or the spinal cord 
from a case of hydrophobia, or from a case of rabies 
produced experimentally in one of the lower animals, we 
find certain lesions present. These lesions differ in ex- 
tent in different cases and also in the type of lesion 
which predominates in a particular case. This depends, 



APPENDIX TO THE MINUTES. 355 

among other factors, upon the severity of the infection 
and upon the length of time the parts have been exposed 
to the poison before death ensues. 

The walls of the blood vessels and the peri-vascular 
lymph spaces are seen to be crowded with escaped leu- 
cocytes. Accumulations of leucocytes are also seen 
apparently at a distance from any blood vessels, in among 
the ganglion cells, forming areas of exudation. Besides 
this emigration of white blood cells, there are also often 
present small collections of red blood cells in the tissues, 
constituting small hemorrhages. Apparently independent 
of the exudation, and yet due to the same general cause, 
/. e,y the poison of rabies, is a more or less complete 
degeneration of the ganglion cells, an acute parenchy- 
matous degeneration. This exudative inflammation fol- 
lows the same laws as exudative inflammations in other 
parts of the body, modified only by the character of the 
tissues involved. 

Third, — Acute Productive Inflammation. In the case 
of rabies already referred to, there may be, besides the 
accumulation of leucocytes in the tissues, and especially 
in the walls of the blood vessels and in the lymph spaces 
'surrounding them, some new connective tissue cells pre- 
sent in the vessel walls resulting from the prolifer- 
ation of the connective tissue cells normally found there. 
This lesion is, however, usually not well marked. If, 
however, we examine a transverse section of the spinal 
cord from a case of Landry's paralysis, we find, be- 
sides the degeneration of the ganglion cells, and the 
presence of some leucocytes in the vessel walls, that there 
is a considerable production of new connective tissue 
elements, this part of the lesion sufficiently predominat- 
ing to warrant giving the picture the name of acute pro- 
ductive inflammation. Depending upon the stage of pro- 



356 MEDICAL SOCIETY OF NEW JERSEY. 

gress of the disease at the particular point from which 
the section is taken at the time of death, the associated 
exudative features may be more or less prominent, giving 
to the lesion the character of a simple productive inflam- 
mation or of a productive inflammation with exudation. 
This lesion, again, differs in no way from the lesion of 
acute productive inflammation as found in the other 
tissues and organs of the body. 

Fourth, — Chronic Productive Inflammation. Either 
following the long continuation of a productive inflam- 
mation or as a disease sui generis, there is found a chronic 
production of new connective tissue as a result of prolifer- 
ation of the connective tissue elements of the nervous sys- 
tem. This type of inflammation in the nervous system is 
usually associated with the same general conditions and 
diseases as similar lesions in other parts of the body ; thus,, 
chronic alcoholism, gout, rheumatism, syphilis, often act 
as predisposing causes. This type of inflammation is 
well seen in a section of the spinal cord in a case of 
multiple sclerosis, stained by the method of Weigert 
which, it will be remembered, stains only the med- 
ullary sheaths of nerve fibres. The areas of new 
connective tissue are, therefore, seen as light yellow 
spots of about the same color as normal grey matter 
under the same stain. A point of considerable interest 
fails to show in this picture owing to the stain. 

A specimen from the same case stained by the picro-acid- 
fusion method of Van Gieson shows it very distinctly^ 
It is that in this form of inflammation the new tissue 
consists of not only the connective tissue formed as a 
result of the proliferation of cells in the walls of the 
blood vessels, and in the connective tissue septa sent into- 
the cord from the pia mater, but also of a proliferation 
of the neurolgia cell and fibres, /. ^.,.the connective tissue 



APPENDIX TO THE MINUTES. 357 

peculiar to the nervous system. This makes still more 
perfect the analogy to the chronic productive inflamma- 
tions found in the other organs. The two kinds of con- 
nective tissue retain their identities unless the process 
has gone on to such a stage that nothing but dense scar 
tissue is demonstrable. 

The conclusions to which the application of the new 
technique has brought us in the realm of normal and 
pathological histology are as follows : 

In Normal Histology. 

1. The method of Golgi has given us a definite and cleaf 
conception of the general architecture of the central 
nervous system, and has demonstrated its analogy to that 
of the other organs of the body. 

2. The method of Nissl has enabled us to make great 
advances in the cytology of the central nervous system. 

In Pathological Histology. 

1. The method of Golgi has proved of comparatively 
little value. 

2. The method of Nissl has aided us in penetrating 
the mysteries of the pathological cytology of the nervous 
system, and with the aid of previous methods, and in 
the light of the already described analogy in structure 
of the nervous system to that of the other organs, to 
bring the hitherto isolated pathology of the nervous 
system into harmony with the pathology of other organs 
of the human economy. 



23 



OBITUARIES. 



fin i^tmovmm. 



HENRY E. BRANIN, M.D., 

Born January 8, 1836. 
Died October 6, 1897. 



ORANGE W. BRAYMER, M.D., 

Born June 14, 1865. 
Died January 8, 1898. 



JONA S. WHITAKER, M.D., 

Born January 20. 1823. 
Died February 14, 1898. 



H. G. H. BUCKINGHAM, M.D., 

Born March 22, 1837. 
Died April 4, 1898. 



JOHN J. H. LOVE, M.D., 

Born April 3, 1833. 
Died July 30, 1897. 



fin Mtmovmm. 



HENRY B. CRANE, M.D., 

Born July 28, 1856. 
Died March 23. 1898. 



JOHN D. BRUMLEY, M.D., 

Born May 3, 1834, 
Died January 8, 1897. 



THOMAS H. ATKINSON, M.D., 

Born July 17, 1872. 
Died February 5, 1898. 



ISAAC N. QUIMBY, M.D., 

Bom August 5, 1 83 1. 
Died May 6. 1898. 



CHARLES R. BURROUGHS, M.D., 

Born Februaay 12, 1853. 
Died November 10, 1897. 



ft 

fin JJlemoriaitt* 



JOSEPH R. S. FARROW, M.D., 

Born October 2, 1870. 
Died June 23, 1898. 



WILLIAM S. PATRICK, M.D.. 

Born September 14, 1864. 
Died November 17, 1898. 



DEWITT C. HOUGH, M.D., 

Born December 31, 1826. 
Died August 25, 1897. 



THOMAS H. MANNING, M.D., 

Bom January 6, 1861. 
Died May 19. 1898. 



OBITUARIES. 



HENRY ELY BRANIN, M.D. 

BY E. L. B. GODFREY, A.M., M.D., CAMDEN, N. J. 

Dr. Henry Ely Branin was bom at Medford, Burlington County, 
N. J., January 8, 1836, and died at his residence in Blackwood, N. J., 
of hemorrhagic apoplexy, October 6, 1897, in the sixty-second year 
of his age. 

Dr. Branin began preparation for the profession of medicine early 
in life, at the West Jersey Collegiate Institute, Mt. Holly, N. J., and 
completed his academic course of study at the New York Conference 
Seminary, Charlottesville, N. Y. He commenced the study of medi- 
cine under the preceptorship of Dr. E. A. Budd, of Mt. Holly; entered 
Jefferson Medical College, of Philadelphia, in 1856, and was graduated 
a Doctor of Medicine in the class of 1858. On April ist of that year 
he located at Blackwood, where he resided and practiced his profession 
until his death. 

Dr. Branin was made a licentiate of the Medical Society of New 
Jersey in i860. This step was highly creditable to him and evidenced 
his loyalty to the Society, since at that time it was not necessary to 
appear before the censors of the State Society for a medical license. 
During the Colonial period, in 1772, medical examinations were insti- 
tuted under the supervision of the Supreme Court of New Jersey, 
which were continued until 181 6, when the State Medical Society was 
re-incorporated with power to appoint its own censors to examine and 
license candidates for the practice of medicine in this State. This 
was the only legal way of entering the medical profession of New 
Jersey until 185 1, when the law was amended to admit the gradu- 
ates of certain medical colleges in New York and Philadelphia without 
examination before the censors, and in 1854 was further amended to 
admit to practice the graduates of any incorporated medical college 
in the United States, without examination, upon filing a translated 
copy of their diploma with the clerk of the county in which they 
intended to practice. The censorship of the State Medical Society 
was, therefore, practically abrogated over the admission into the ranks 



364 MEDICAL SOCIETY OF NEW JERSEY. 

of the medical profession of New Jersey, and in 1866 it was volun- 
tarily surrendered to the State.* 

In i860 Dr. Branin was elected a member of the Camden County 
Medical Society, and was made President of the Society in 1862. He 
frequently served as a delegate to the Medical Society of New Jersey, 
before which he presented a number of valuable medical papers, and 
was a member of the New Jersey Sanitary and American Medical 
Associations. 

In 1880 he was elected medical director of the Camden County 
Insane Asylum, which position he held until his death, in 1897. He 
was also physician to the Camden County Almshouse for a number 
of years. In November, 1880, typhus fever was introduced into the 
almshouse through the admission of a subject from a sailor's boarding- 
house in Philadelphia. On account of the overcrowding of the 
building, the severe winter weather, the bad ventilation and insufficient 
nursing, the fever attained the proportions of an epidemic of 103 
cases, with 33 deaths, and was not subdued until April, 1881. In 
point of intensity and duration, it was the most extensive epidemic of 
typhus fever ever known in New Jersey. Dr. Joseph W. McCuUough, 
of Blackwood, was at that time physician to the almshouse, and died 
in the performance of his duty, of the fever, in March, and was 
succeeded by Dr. Joseph E. Hurff, of Blackwood. Appropriate 
notice of his life and services was published in the Transactions of 
the Medical Society of New Jersey for 1881. Dr. Branin was con- 
tinuously associated with Dr. McCuUough in the management of the 
epidemic, and published an elaborate paper, entitled " The History. 
Origin, etc., of the Epidemic of Typhus Fever at the Camden County 
Almshouse " in the Transactions of the Medical Society of New 
Jersey for 1881. 

In 1884, the Camden County Medical Society adopted a series of 
resolutions " expressive of the bravery, skill, intrepidity and devotion 
to duty of Drs. Branin and McCuUough during this deadly epidemic." 
On May 10, 1898, the annual meeting of the Camden County Medical 
Society was held at the almshouse, Blackwood, when an elaborate 
tablet of brass, fittingly inscribed and commemorative of the distin- 
guished services of Drs. McCuUough and Branin during the epidemic 
of typhus fever, was presented by the Society to the Board of Chosen 



*•• History of the Medical Profession of Camden County, N. J." The F. A. 
Davis Company, of Philadelphia, publishers. 



OBITUARIES. 365 

Freeholders of the County, and erected in the almshouse. The 
meeting was made the occasion of a special program and the Society 
was entertained as the guest of the Board of Freeholders. A full 
account of the meeting, with the inscription engraved on the tablet, 
will be found in the report of the reporter of this Society, Dr. John G. 
Doron, to the State Society, published in the Transactions of this year. 
Dr. Branin was a prominent member of both the Society of Odd 
Fellows and the Masons. He belonged to I. O. O. F. of Blackwood ; 
Florence Lodge, F. & A. M., of Woodbury; Siloam Chapter, R. A. M., 
of Camden, and was a member for many years of the Board of 
Trustees of the Presbyterian Church of Blackwood. Dr. Branin was 
a man of admitted ability and learning and of unquestioned integrity 
and courage. In point of loyalty to his profession, his course of 
action in the epidemic at the Camden County Almshouse, like that of 
Dr. McCullough, stands unsurpassed in the history of medicine in 
New Jersey. No higher appreciation of his services can be manifested 
than that shown by the Camden County Medical Society of May 10 ; 
no greater evidence of his intrinsic worth can be given than his 
repeated election as medical director of the Camden County Alms- 
house by a Board of Chosen Freeholders of an opposite political faith, 
and no better instance of his popularity among his neighbors need be 
mentioned than his position as a director of the public schools of 
Blackwood for a period of thirty-seven years. 



ORANGE W. BRAYMER, A.M., M.D., PH.D. 

BY E. L. B. GODFREY, A.M., M.D., CAMDEN, N. J. 

Dr. Orange W. Braymer died suddenly at his residence on West 
Street, Camden, on January 8, 1898, in the thirty-third year of his age, 
■of septic inflammation of the brain, superinduced by septicaemia 
resulting from an operation in surgery. 

Dr. Braymer was born in Meadville, Pa., June 14, 1865. In 1882 
he entered Allegheny College, from which he was graduated in 1886 
with the degree of A.B., and from which he received the degree of 
A.M. in 1889, and of Ph.D. in 1892. He studied medicine in the 
Medical Department, Western Reserve University, of Cleveland, Ohio, 
and at Jefferson Medical College, of Philadelphia, and was graduated 
from the latter institution in 1888. The same year he located in 
Camden where he remained until his death. Dr. Braymer 's success 
in the practice of medicine and surgery was uninterrupted and he 



366 MEDICAL SOCIETY OF NEW JERSEY. 

won and maintained, in an eminent degree, the confidence and 
respect of both the profession and the laity. The special work of 
Dr. Braymer was surgery, and as a member of the Cooper Hospital 
staff he successfully performed the varied operations that fall within 
the province of the hospital surgeon. He was a member of the 
Faculty of the New Jersey Training School for Nurses and attained a 
widespread reputation as a lecturer on anatomy. His papers, read 
before the various medical societies with which he was connected^ 
were well received and he contributed frequently to the Journal of 
the American Medical Association, the International Journal of Sur- 
gery and other medical periodicals. 

Dr. Braymer was a member of the Camden City Medical Society, 
of which he was President in 1895, the Camden County Medical 
Society, the Cooper Medical Club, the Medical Society of New Jersey, 
the New Jersey Sanitary Association, the Military Order of Surgeons 
of New Jersey, the American Medical Association and the American 
Academy of Medicine. He was also physician to the Camden Home 
for Friendless Children and a member of the Board of Managers of 
the Camden City Dispensary. In 1893 Dr. Braymer was commissioned 
First Lieutenant and Assistant Surgeon, Sixth Regiment, N. G. N. J.^ 
on the staff of Col. William H. Cooper, from which he resigned about 
a year before his death. He also served as medical examiner for 
Camden for the Metropolitan Life Insurance Company, of New York.. 
In addition to his professional associations, he was a member of 
Trimble Lodge. F. & A. M., a Royal Arch Mason, a member of the- 
Independent Order of Odd Fellows, of the Ancient Order of United 
Workmen, the Independent Order of United Red Men, and of the 
Order of Chosen Friends. 

The funeral sermon was preached by Rev. James C. Russell, the 
pastor of the Second Presbyterian Church, of which Dr. Braymer 
was a member. The Camden medical societies attended the funeral 
at the church in a body, and the burial was made at Harleigh Ceme- 
tery, with Masonic rites. 



JONATHAN SHEPPARD WHITAKER, M.D. 

BY JOSEPH SHEPPARD, M.D., BRIDGPTON. N. J. 

Dr. Jonathan Sheppard Whitaker was born January 20, 1823, at 
Cedarville, N.J. He was the son of Thomas and Deborah Whitaker 
and received his earliest education at the public school in Cedarville^ 



OBITUARIES. 367 

He then took an academic course in Bridgeton, after which he entered 
Jefferson Medical College, Philadelphia, and graduated from that 
institution in 1845. He located in Centreton, N. J., where he began 
the practice of his profession. While in Centreton his career was 
marked by the same push, energy and charitable characteristics which 
made him one of Millville's leading citizens. After a number of years 
he moved to Elmer, N. J., and in 1861 came to Millville. where he 
practiced until 1893. While in Salem County he took an active 
interest in politics, being a staunch Democrat, and held a number of 
county offices. Upon his coming to Millville he at once took an 
active part in municipal affairs and was for many years a member of 
the Board of Education and at one time President. 

In 1884 Governor Ludlow appointed Dr. Whitaker to the Lay 
Judgeship of the Court of Errors and Appeals, to fill the unexpired 
term caused by the death of Dr. Wales. At the expiration of his term 
he was reappointed for another term. He was a member of the First 
Presbyterian Church and attended divine worship there until within a 
few months of his death. He was one of the prominent factors in the 
establishment of the Shekinah Lodge of Free and Accepted Masons 
and for many years was a trustee of the same. He also held the 
office of Past Master. He was Past High Priest of Richmond Chapter 
of Ro)al Arch Masons, and Past Eminent Commander of Knights 
Templar and Knights of Pythias, being a past officer in that lodge for 
many years. He was a prominent Odd Fellow, being at one lime 
Grand Master of the State of New Jersey, and several times a repre- 
sentative to the Grand Lodge of the United States. He was also a 
member of the Heptasophs and Chosen Friends. In 1892 his health 
failed him, which is not surprising after such an active life His 
death occurred February 14, 1898, and was due to progressive paresis 
following apoplexy. 

A member of every family of Millville for more than five years has 
heard of Dr. Whitaker, and always in the terms of utmost respect 
We can safely say there is not a person in the city but who will gladly 
do tribute at his bier and consider it a favor to be allowed to do so. 
Dr. Whitaker was a man possessed of a heart several times larger 
than his body (allegorically speaking), who seemed to delight ia 
charitable and public minded deeds. He had for many years a large 
practice until his age and failing health compelled him to give it up. 

A book could be written about his good deeds and yet there would 



368 MEDICAL SOCIETY OF NEW JERSEY. 

be more to relate. We know of instances where he has been called 
to administer relief where the head of the family was ill. The disease 
afflicting the patient being such as to demand an operation, he sent the 
father to Philadelphia, bore all the expense of the operation and kept 
the wife and little ones while they were without their parent. Acts of 
similar kindness and of as generous a magnitude have occurred not 
only once, but many times. He was at all times interested in the 
good government of the city and did all that any one citizen could do 
to make the city prosper. We are not exaggerating, but simply 
speaking the truth when we say that we fail in words to express the 
high esteem in which Dr. Whitaker was held by the fellow-citizens 
of Millville. 



HENRY GAYLORD BUCKINGHAM, M.D. 

Henry Gaylord Buckingham was born in the village of Northfield, 
Litchfield County, Conn., March 22, 1837. His father's name was 
Sheldon Buckingham and his mother's maiden name, Anne Eliza 
Gaylord. While he was quite young his parenis removed to New 
York State, but at the age of seventeen he returned to Connecticut 
and afterwards attended school at Wilbraham, Mass. He was self- 
educated, by turn teaching and again attending school. He also 
attended two terms (about eighteen months) at the Sheffield Scientific 
school. New Haven, Conn. He taught for some time in Dr. Wilcox's 
military school, in Stamford, was for a short period assistant super- 
intendent in the House of Refuge for boys, in Philadelphia, and also 
taught at Lancaster, Pa. Later he was one of the faculty in Falley 
Seminary, Fulton, N. Y., then principal of the public schools of that 
place. He pursued a medical course in Syracuse University, gradu- 
ating there in the year 1873, ^.nd the next fall entered the senior class 
of the medical department of Columbia College, New York city, 
graduating in 1874, In the summer of '74 he bought out the practice 
of Dr. A. G. McPherson, in Clayton, N. J., and there pursued his 
profession so long as he lived. He joined the County Society in 
January, 1875, the State Society the same year, and the American 
Medical Association in 1876. He died April 4, 1898. Dr. Bucking- 
ham was an invalid during two years and bore his sickness with 
patience, even cheerfulness. A widow survives him. 



OBITUARIES. 369 

JOHN JAMES HEROEY LOVE, M.D. 

Bom April 3, 1833; died July 30, 1897. Dr. Love was the son of 
the Rev. Robert and Anna Thompson (Fair) Love. He was the 
eldest of four children and first saw the light in Harmony, Warren 
County, N. J., where his father was at that lime pastor of the Presby- 
terian Church. His ancestors on both sides were of Irish Presbyterian 
extraction. His father died when he was about eight years old, and 
he seems to have received most of his education through the kind 
interest of two or three of his uncles. He was fitted for college in a 
private school and graduated from Lafayette College, in East on. Pa., 
July 23, 1 85 1 . Shortly after this he began the study of medicine in 
the office of his uncle, Dr. Fair, of Pompton, N. J., attending lectures 
at the medical department of the University of New York, from 
which he graduated in 1855. He immediately settled in what is now 
Montclair, where he remained in the active practice of his profession 
until his death forty-two years later. 

In June, i860, he married Miss Frances J. Crane, who. with a soa 
and two daughters, survives him. The son, Mr. Leslie C. Love, 
graduated in the arts at Princeton University in 1895, and is now 
studying in the medical department of Columbia University, where he 
has acquitted himself with much credit, and gives promise of becoming 
a worthy successor of a noble sire. 

In the spring of 1862 Dr. Love offered his services to the govern- 
ment temporarily and went to the front, and later in that year he 
went to the war as surgeon of the Thirteenth New Jersey Infantry. 
He was present at the battles of Antietam and Gettysburg and some 
minor engagements. In the latter part of '63 he was appointed a 
division surgeon in the army of the Potomac. In January, 1864, he 
resigned from the army and returned to Montclair. From this time 
to the end of his life his history was the history of the town. He was 
never away from his post. Whatever he thought was for the best 
interests of the community he undertook with zeal and carried out 
with persistence. His work on the school board was, perhaps, his 
most noteworthy and successful achievement outside of his profes- 
sional career. For over twenty-five years he was clerk of the Board 
of Education and for six years previously he had been its president. 
To his steady, enlightened and progressive policy the great success of 
the Montclair public schools is mainly due. 

In recognition of his unparalleled public services and his forty 



370 MEDICAL SOCIETY OF NEW JERSEY. 

years of successful practice in Montclair, he was tendered a banquet 
by his fellow-townsmen in April, 1895. At this dinner one hundred 
and seventy-six guests were present. Dr. George L. Shrady, of New 
York, and the Hon. Franklin Murphy, of Newark, were amongst the 
speakers. Shortly after this a portrait in oil was painted of the 
doctor and hung in the assembly room of the Montclair High School, 
where it still remains. The price of the painting was collected in 
small sums from over three hundred subscribers. 

Dr. Love spent a portion of ^he summer of 1895 in Europe, whither 
he went in company with his lifelong friend, Dr. Pierson, of Orange, 
and Drs. Graves and Runyon, in quest of recreation and rest from 
the overpowering duties of his professional and public life. He 
returned greatly invigorated and took up his work again with renewed 
zeal. In the spring and early summer of 1897 he again showed signs 
of failing health and at the earnest solicitation of his family and friends 
had completed his arrangements for a month's vacation trip to the 
Provinces, when two or three days before the date fixed for the start, 
he was called out one morning at about five o'clock to assist in a 
difficult midwifery case. Responding, as he had ever done, to the 
cry of distress or to a summons to aid a brother practitioner, he went 
to the case, and after considerable exertion succeeded m accomplish- 
ing the delivery and saved the life of mother and child. But at what 
a terrible cost ! Passing to the other side of the room he became 
faint, sank upon the floor and in five minutes was dead. 

The story of the man's life was almost told as he lay upon the floor 
of that humble dwelling, his sleeves rolled up above his elbows, his 
hands still bloody lying peacefully at his sides, an old gingham apron 
pinned in front of his clothes, his face calm and peaceful. The sight 
was one which the writer can never forget. It was sublime. He had 
fallen at his post. The summons, " Well done, thou good and faith- 
ful servant, enter thou into the joy of thy Lord," had reached Dr. 
Love just as he had accomplished with great skill, patience and 
generosity that part of a physician's duty which awakens our tender- 
est emotions and calls forth our highest powers. No true man can 
think of his own mother, who brought him into the world with 
indescribable suffering and whose unselfish, unfathomable love 
followed him so long as she lived, and not strive with his best 
endeavor to help every other woman through this difficult and trying 
time. Dr. Love died as he had lived, in the quiet and unostentatious 
performance of his duly. 



OBITUARIES. 371 

At the time of his death he was third Vice-President of the Medical 
Society of New Jersey, President of the medical staff of the Mountain- 
side Hospital, member of the American Academy of Medicine, the 
American Medical Association, the New Jersey Academy of Medicine, 
member and ex-President of the Orange Mountain Medical Society 
and of the Essex District Medical Sociey. Member of the Board of 
Managers of the Rosedale Cemetery Company; President of the 
Montclair Gas & Water Company ; Secretary of the Society of Veter- 
ans of the Twelfth Army Corps (of this famous corps he had written 
a history not yet published), and President of the Society of Veterans 
of the Thirteenth N. J. Volunteer Infantry. He was a companion of 
the New York Commandery, Military Order of the Loyal Legion of 
the United States. He was a member of the Trinity Presbyterian 
Church of Montclair and President of its Board of Trustees. He 
was a director and ex-President of the Montclair Club. As said 
before, he had been clerk of the Board of Education of the town of 
Montclair over twenty-five years and its President six years. He had 
been for three years a member of the Town Committee of the town- 
ship of Montclair, and for many years had held the office of Commis- 
sioner of Appeals. He had been one of the committee who had 
selected the present admirable site of the Essex County Penitentiary. 
He had served many years on the Republican County Committee, and 
had he desired political office could probably have enjoyed almost any 
office, State or national, in the gift of his party. He had been 
President of the Montclair Library Association and afterwards of the 
Board of Trustees of the Free Public Library. He had written 
some medical papers and addresses of value, and had devised a 
treatment for puerperal eclampsia, for which he deserved great credit 
but which the profession-at-large has been slow to adopt. He treated 
these cases with veratrum viride and benzoic acid, and was bitterly 
opposed to forced delivery. He was able to show the most successful 
series of results so far reported, viz., twenty-five or more cases with 
only one death. The treatment of puerperal eclampsia with veratrum 
viride is now, however, gaining ground, and was reported upon very 
favorably by the late Prof. Theophilus Parvin to the International 
Congress of Gynecology and Obstetrics, which met at Geneva, Switzer- 
land, in 1896. 

Dr. Love was a man of splendid physique and distinguished presence, 
which, added to the natural nobility and beauty of his features, made 



372 MEDICAL SOCIETY OF NEW JERSEY. 

him a remarkably handsome man. He came, as said before, from 
that sturdy, honest and thrifty race, the Scotch-Irish Presbyterians^ 
whose vigor, devotion to principle and strong racial characteristics 
have always excited the admiration of the world. Although deprived 
in early life of the counsel and guidance of his father, he enjoyed the 
love and sympathy of his mother until a few years before his death. 
She lived to see her son honored and respected and was the grateful 
recipient of his bounty for many years. 

Dr. Love's relations to the profession were especially commendable. 
He once informed the writer that he had never exchanged bitter 
words nor quarreled with another physician in his life He was the 
friend and counsellor of all his younger associates. His vast store 
of experience was freely offered to others. While he was the acknow- 
ledged leader, he was very careful not to infringe the rights or injure 
the feelings of others. While on duty in the hospital his private 
interests were often sacrificed to his public duties. A man of excel- 
lent judgment and rare attainments, to have enjoyed his friendship 
was a liberal education. Even now his fellow townsmen have formed 
themselves into a Love Memorial Association for the express and 
avowed purpose of raising, by popular subscription, a sum of not less 
than $4o,ooo^for the purpose of erecting a Love Memorial Building, 
which shall contain the Montclair Free Public Library and a memorial 
room to commemorate the services to the town and to their country 
of Dr. Love and other public-spirited citizens. This building is 
meant to stand for all time as a monument to the man who built up 
and maintained Montclair's splendid public school system, to the 
man whose public and private career was without fear and without 
reproach, whose conception of his civic and professional obligations 
was determined by a broad-mindedness and an altruistic sense such 
as few men possess. And, unfortunately, few men so equipped have 
the felicity of living, as did Dr. Love, to see their ideas accomplished 
and their labors bearing fruit. 

It was said of Dr. Love at the time his portrait was presented tO" 
the Montclair High School, and it may just as appropriately be said of 
him in respect to the present movement to erect a library building to 
his memory, " People of all ranks of life, of all professions and 
callings, all religious sects and political parties, dropped their differ- 
ences and united heartily and harmoniously in paying a deserved 
tribute to a genuine man." 



OBITUARIES. 373 

HENRY BEDELL CRANE, M.D. 

Dr. Henry Bedell Crane died from pneumonia on Wednesday, 
March 23, 1898. He was born near Deckertown, Sussex County, 
N. J., on July 28, 1856. He came to Newark with his parents when 
quite young and was educated in the public schools of the city. He 
was graduated from the High School in Newark, and afterwards took 
a course in the Philadelphia College of Pharmacy, from which he 
received a diploma. In 1880 he was married to Miss Kate Car)'ell, at 
Orange, shortly after which he was matriculated in the medical 
department of the University of Pennsylvania and in due time receivedl 
the degree of M.D. from this school. In 1884 he returned to Newark: 
and began the practice of his profession. He was industrious andi 
successful. For a short time he was attached to the staff of the 
Hospital for Women and Children. From this he resigned and since- 
has not been connected with any hospital. He was elected a member 
of the Essex District Medical Society in 1893. He was an elder in 
the Park Presbyterian Church and took a keen interest in the welfare 
of the parish. With Rev. Dr. French and others he was influential 
in establishing the Industrial Home for Men, which was opened about 
two years ago in Newark. He was an active prohibitionist and once 
ran for Coroner of the county on the Prohibition ticket. He was a 
member of the Masonic Fraternity and of some beneficiary societies^ 
He leaves a widow and four children. 



JOHN DUANE BRUMLEY, M.D. 

John Duane Brumley, M. D., was born in Montville, Conn., May j.. 
1834; he died at Newark, January 8, 1897. He received a common 
school education in the town of his birth and in 1853, at the age of 
19, he began the study of medicine under the tutelage of Dr. John P. 
Fuller, of Norwich, Conn., and entered the New York Medical 
College where he attended two full courses of lectures, and in 1856 
he received the degree of Doctor of Medicine. After graduation he 
began practice in Newark, which city was afterwards his home. Here 
he lived and practiced continuously until the time of his last illness, 
with the exception of the four years during which he served his 
country at the front during the War of the Rebellion. His war 
record was very creditable. He enlisted and was assigned to the 
Seventh Michigan Volunteers. His term of service expiring during 

24 



374 MEDICAL SOCIETY OF NEW JERSEY. 

the Seven Days' Battle, in June, 1862, he re-enlisted and was made 
acting assistant surgeon. Having been captured he was for a month 
a prisoner in Libby Prison. Later he was assigned to the charge of 
the Division General Hospital, at Memphis. Tenn. In January, 1864, 
he was sent to Louisville as General Superintendent of Hospitals of 
the Department of the Cumberland. He was afterwards appointed 
Surgeon-in-Chief of the First Division of the Fourth Corps of the 
Army of the Cumberland. He was also at one time medical inspector 
and acting medical director. For these services Dr. Brumley was 
breveted Lieut.-Coloncl. 

At the close of the war Dr. Brumley resumed practice in Newark. 
He several times received political honors at the hands of his fellow- 
citizens. He was for two terms a member of the Board of Education, 
and in 1881 filled the office of health physician. In 1869 Dr. Brumley 
was appointed one of the attending surgeons of the Hospital of St. 
Barnabas, and held the position continuously until 1881 when he 
resigned. He held the position of U. S. Examining Surgeon for 
Pensions from 1878 to 1885. In 1882 he was appointed surgeon 
to the New Jersey Home for Disabled Soldiers and continued service 
in this capacity until 1891. In 1886 the Essex District Medical 
Society elected Dr. Brumley to the position of President. He was a 
member of the Society for the Relief of the Widows and Orphans of 
Medical Men of New Jersey and was for many years one of the 
Board of Trustees ; surgeon of the Hospital for Women and Children, 
of Newark ; member of the Society of the Army of the Cumberland, 
and was one of the founders of the Practitioner's Club, of Newark, 
and was its first President. 

Dr. Brumley was interested in everything that honored his profes- 
sion, increased its usefulness or furthered its aims. He was enthusi- 
astically in favor of the scientific sessions of this Society and was a 
faithful worker in the New Jersey Academy of Medicine. His aim 
was progressive and he was always ready to fight in the ranks to 
attain it. His was a quiet energy, but it generally reached its object. 
He was not obtrusive, but his opinions were sound and his judgment 
excellent, and for many years he had a very large professional follow- 
ing. For the last year of his life Dr. Brumley 's health was precarious, 
but (luring the summer there was a marked improvement in his cou- 
diiion. In the fall, while comparatively well, he was seized without 
warning with an alarming pulmonary hemorrhage, which a critical 



OBITUARIES. , 375 

examination proved to be tuberculosis. After this the progress of the 
disease was rapid and made no stay until the end came just after the 
coming in of the year. 



THOMAS HANLON ATKINSON, M.D. 

BY F. D. GREY, M.D.. JERSEY CITY, N. J. 

Dr. Thomas Hanlon Atkinson, died of typhoid fever, in this city, 
after an illness of nearly five weeks. He was born in Jersey City, 
July 17, 1872, and died February 15, 1898. His father was the late 
Rev. John Atkinson, D.D., whose death, less than two months prior 
to that of his son, was such a distressing coincidence to the family 
and friends. 

Dr. Atkinson's preparation for his professional work was most 
thorough, beginning with his attendance at Hasbrouck Institute from 
1884 to 1886, after which he entered Pennington Seminary, where he 
graduated in 1888. This preparatory training was followed by a 
collegiate course at Wesleyan, from which he graduated with honor 
in 1892. Having decided to enter the medical profession, he matricu- 
lated at the College of Physicians and Surgeons, of New York city, 
and there received the degree of M.D. in 1895. Shortly afterwards 
he passed the N. J. State Board of Medical Examiners with the 
highest average in a class of twenty-six, thus entering his chosen 
profession at the early age of barely twenty-three. He at once 
became associated professionally with Dr. F. D. Gray, and in the 
following two and one-half years of active work had firmly established 
himself in the esteem and confidence of a large circle of patients and 
acquaintances. 

Dr. Atkinson was not only a member of our Society, but also of 
the Practitioners' Club, of Jersey City, in both of which he took a 
commendable interest. Among the social and political clubs, he 
belonged to the Palma and the Union League, in the latter of which 
he was especially active. By virtue of his appointment, last July, to 
be City Physician of the First Health District, he became a member 
of the Jersey City Board of Health, where his counsels were highly 
regarded. It may be said of Dr. Atkinson that while only on the 
threshold of manhood he had already demonstrated his ability to 
secure more than the usual degree of success along professional as 
well as other lines, and it is only in recognizing a higher power con- 
trolling our destinies that we can reconcile justice with such a sudden 
and premature termination of a career of promise* 



37^ MEDICAL SOCIETY OF NEW JERSEY. 

ISAAC N. QUIMBY, M.D. 

Dr. Isaac N. Quimby was one of the oldest and most prominent 
])hysicians in Jersey City and took an active part in public affairs. 
He was born at Bemardsville. near Basking Ridge, Somerset County, 
N. J., on August 5, 1 83 1. He was the son of Nicholas Emmons and 
Rachel Stout Quimby, grandson of John Quimby. great-grandson of 
Judge Nicholas Emmons, of the Supreme Court of New Jersey. 
Both his grandfathers were patriot soldiers in the War of the Revo- 
lution, while his father served in the War of 1812. 

Dr. Quimby was left an orphan at an early age, and was forced to 
depend upon his own resources. His early employment was farming, 
and at the age of nineteen he had also acquired a practical knowledge 
of the milling business. About the year 1851 he went West and 
engaged in the flour and milling business at Somerville and Zanesville. 
Ohio. There he formed an acquaintance with Dr. Barr, who advised 
him to undertake the study of medicine, and for three years he pur- 
sued this study in connection with his daily labors. At the same 
time, by economy, he accumulated means sufficient for a preparatory 
course at the Chester Institute, Chester, N. J., then a flourishing 
collegiate school under the late Prof. Rankin ; matriculated at the 
University Medical College, New York city, in 1856, and was gradu- 
ated second in his class with a special certificate of honor in 1859. 

Upon the breaking out of the rebellion he entered the army as a 
volunteer surgeon ; served with Gen. McClellan's forces in the swamps 
of the Chickahominy, in the Seven Days' Battle and ** change of base " 
to the James River, and the retreat to Harrison's Landing; was at 
Antietam and remained with his division until after the battles of the 
Wilderness when, on account of illness, he returned home, and 
shortly after resumed the practice of medicine, in which, up to the 
time of his death, he was actively engaged. 

He was lecturer in the spring course of the University Medical 
College, New York, 1866-68, and also assistant to Prof. A. C. Post in 
his surgical clinic at the same institution. He was the originator of 
the Hudson County, now Christ Hospital, in 1868, and was surgeon 
to the same until 1873. He was also one of the attending surgeons 
of the City Hospital, Jersey City. 

He was a member of the American Medical Association, and of its 
judicial council ; was one of the founders and the first chairman of 
the section of medical jurisprudence of that association ; a member 
of the Hudson County District Medical Society, of the American 



OBITUARIES. 377 

Public Health Association, of the Medico-Legal Society of New 
York, of the New York Society of Jurisprudence and State Medicine, 
of the Mississippi Valley Medical Association ; honorary member of 
the Gynecological Society of Boston ; member of the British Medical 
Association, of the American Association for the Cure of Inebriety; 
was a delegate from the American Medical Association to the Inter- 
national Medical Congress, London, 1881, again in 1884, in Copen- 
hagen, and again in 1894, at Rome, Italy. He was a member of the 
first Pan-American Medical Congress, which met at Washington, 
D. C, in September, 1893. 

Dr. Ouimby devised several important improvements in surgical 
operations : " A New Mode of Treatment of Congenital Talipes," 
"Transactions of the American Medical Association," "A New 
Method of Amputation of the Ankle Joint," *' A Case of Compound 
Fracture of the Tibia and Fibula," and operation on parallel bones 
by which the amputation of a limb may be avoided, " The Criminal 
Use of Chloroform," an original investigation which grew out of his 
work as an expert in the Smith-Bennett murder trial in Jersey City. 
He was one of the founders of the American Medical Temperance 
Association in 1891, Vice-President in 1891 to present time, and 
delivered an address before the World's Temperance Congress at 
Chicago, in 1893. He also wrote a paper on the *' Pathological Action 
of Alcohol in Health and Disease," read before the New Jersey State 
Temperance Alliance, printed by that society in a pamphlet edition of 
5,000 copies and circulated throughout the State. 

He was nominated for Govenor by the Prohibitionists of New Jersey 
in 1883, but declined the honor. He was president of the first 
Citizens' Association of this city in 1870, and was instrumental in 
breaking up a corrupt official ring which then controlled the affairs of 
the city. He was also one of the originators of the Anti-Monopoly 
Union of Hudson County, and it was largely through his industry and 
zeal that the railroad bill known as Bill 167 was defeated in the Legis- 
lature of 1882. He was a member of the Board of Trade. 

Dr. Quimby married Miss Helen Stark, daughter of the late Thomas 
McKie, a retired merchant of New York, in 1863. Mrs. Quimby died 
in 1868, leaving one son, Alfred C. P. Dr. Quimby, in 1875, married 
Miss Frances A. Flemming, daughter of the late James Flemming, of 
Jersey City. One son, Isaac N., Jr., was the result of this union. Dr. 
Quimby died May 6, 1898, at his home in Jersey City, at the age of 
sixty-seven. 



378 MEDICAL SOCIETY OF NEW JERSEY. 

At a special meeting of the staff of the Jersey City Hospital, held 
Saturday, May 7, 1898, the following resolutions were adopted : 

Whereas, Dr. Isaac N. Quimby, for so many years a member of 
the Jersey City hospital staff, has been removed by death ; therefore, be it 

Resolved^ That we, members of the staff, fully realize how great is 
our loss in being deprived for all future time of the kindly counsel 
and companionship of our late associate, Dr, Isaac N. Quimby. That 
we feel that by his death, not only among ourselves, but in the com- 
munity at large, a vacancy has been created which cannot easily 
be tilled. 

That we tender our mpst sincere sympathy to his family in their 
sad bereavement. 

That a copy of these resolutions be published in the daily papers of 
the city and in the prominent medical journals of the country. 

At a special meting of the Committee on Necrology of the Hudson 
District Medical Society, held at Jersey City, May 7, 1898, to take 
action on the death of Dr. Isaac Newton Quimby, the following resolu- 
tions were unanimously adopted and will be reported at the next 
meeting of the society : 

Whereas, We have learned with deep regret of the death of our 
beloved member, Dr. Isaac Newton Quimby, a man meriting the 
respect of his professional colleagues and the general public ; be it 
therefore 

Resolved, That in the death of Dr. Isaac Newton Quimby. the 
society has lost a most earnest worker and its members a congenial 
friend. 

Resolved, That the profession at large has cause to regret his death 
and the people of this city have lost a public-spirited citizen, one who 
continually guarded the public health and strove to advance the 
welfare of the community. 

Resolved, That these resolutions be spread in full upon the minutes 
of the Society and a copy be sent to the family of our deceased 
brother, the City press, the medical journals of New York, Philadel- 
phia and Chicago. 



CHAS. RICHARD BURROUGHS, M.D. 

BY CHAS. P. BRITTON, M.D. 

Dr. Charles Richard Burroughs was bom February 12. 1853, on his 
father's farm near Pennington, N. J., and spent his boyhood days 
there. His preliminary education was received at the Pennington 
Seminary. He was graduated in medicine from the Long Island 
College Hospital, in Brooklyn, in 1885. Soon after graduation he 
was appointed an assistant physician to the New Jersey State Hospi- 
tal, Trenton, where he spent five years and left behind a record to be 



OBITUARIES. 379 

proud of. He then located in the city of Trenton, succeeding to the 
practice of the late Dr. C. H. Dunham, whose patients had been under 
his care during the Doctor's last illness. He was one of the physicians 
to the Mercer Hospital Dispensary and at his death held the position 
of president to the district medical society. He died very suddenly 
on the evening of November lo, 1897, aged forty-four years, of 
apoplexy. 

He was a man of high professional standing, honorable and high- 
minded in his intercourse with his fellow practitioners, kind, attentive 
and self-sacrificing in the care of his patients, skillful and faithful as a 
medical practitioner, affectionate and devoted to his family, to whom 
his death came very untimely. The Doctor at one time was very 
much interested in surgery, but the care of an ever increasing general 
practice soon interfered with his cultivating the* special sphere. In 
the death of Dr. Chas. R. Borroughs, the district society lost one of its 
faithful members, who always lent a helping hand and a kindly word 
•to those in trouble and whose memory will long live in the recollection 
of his friends and patients. 



JOSEPH R. S. FARROW, M.D. 

Dr. Joseph R. S. Farrow died 9.25 P. M., Thursday, June 23, 1898, 
at his home in German Valley, N. J., after a protracted illness of 
several months. Deceased was the oldest son of Dr. L. Farrow, of 
Middle Valley, N. J., and was born in that village October 2, 1870. 
Very early in life he showed studious aptness, and after a preliminary 
preparation in the village school he attended the select schools of the 
late Rev. James Brewster, of Chester, N. J., and the Misses McGee, 
of Dover, N. J., finishing at the Collegiate Institute at Hackettstown, 
N. J. He soon after read medicine in his father's office, attended the 
medical department of Columbia College in the city of N. Y., and the 
Long Island College Hospital of Brooklyn, N. Y., graduating from 
the latter institution at the annual commencement, 1892. 

After passing the examination of the New Jersey State Board of Medi- 
cal Examiners, he practiced medicine with his father until September 
4f 1893, when he located at German Valley, N. J., where he has since 
successfully practiced his chosen profession, with honor to himself 
and satisfaction to his patrons. He was thoroughly attached to his 
chosen life-work and went about his daily duties quietly, without 



380 MEDICAL SOCIETY OF NEW JERSEY. 

ostentatious display, meeting its arduous duties with promptness and 
despatch. He stood up for the dignity of his profession, and despised 
the ways of the coxcomb and the methods of the charlatan. All 
will bear cheerful testimony that his professional relations with his 
patrons reflected the inherent qualities of a true physician and a 
Christian gentleman. Among his chief traits of character were his 
strict conscientiousness in private and public life and exact methods 
and scrupulous integrity in his business relations with others. He 
was always ready to stand or fall upon his merits, was fearless in 
the discharge of what he believed to be duty and courted no 
unmerited favor. 

He kept himself in touch with his medical brethern and identified 
himself with the Morris County Medical Society, May 8, 1894, and by 
his courteous, unassuming manners, won the esteem and confidence 
of his professional brethern. His social tendencies led him to join 
■several fraternal and benevolent societies, and by his special request, 
his body was carried to its last resting place by delegations from these 
lodges. But the crowning epoch in his short but busy life was his 
triumphant death. " For him to die was gain." He not only bore his 
prolonged illness with Christian fortitude, but looked unflinchingly 
into the face of the king of terrors. Yes, welcomed the advent of the 
silent message that was to solve the mystery of the Beyond. Deceased 
leaves a wife and little boy, a father and only brother and sister, 
together with a large circle of friends. It is a blessed call when the 
Master says, *' It is enough, come up higher." 



W. S. PATRICK, M.D. 

Dr. Patrick was born in Quinton, Salem County, N. J., September 
14, 1864. After a preliminary 'education at the Quinton High School 
he entered Bucknell University in 1885. Graduating at the University 
of Pennsylvania in 1891, he practiced his profession in Woodstown 
until his death, November 17, 1898. 



DEWITT CLINTON HOUGH, M.D. 

BY W. E. CLADEK, M.D. 

Dr. DeWitt Clinton Hough died at his residence in Rahway, N. J., 
August 25, 1897, of apoplexy. He passed away quietly and a life 
full of kindly benefactions, years spent in healing and helping the 



OBITUAKIES. 381 

-sick and suffering, came to an end. He was born at Point Pleasant, 
Bucks' County, Pa., December 31, 1826, in the same township in 
which the late Dr. Samuel Abcrnethy. the first President of this 
:Society was born. He was the son of Gen. Joseph Hough, a promi- 
nent merchant of that place and a man well known throughout the 
State. Dr. Hough was ihe oldest of six children. He began his 
studies at the Newtown Academy, Pa., and later attended the Jeffer- 
son Medical College, Philadelphia, from which he graduated in 1847, 
and began the practice of his profession at once at Tylersport, Pa , 
next at Red Hill for three years, from there to Frenchtown, N. J., for 
six years, and in February, 1857, he settled in Rahway. Of those 
who were then engaged in the practice of medicine, Dr. Silvers alone 
survives. At the breaking out of the Civil War Dr. Hough was com- 
missioned surgeon of the Seventh N. J. Volunteers, serving under 
•Gen. Hooker until the close of the war. He was one of the charter 
members of this Society and in former years was an active member of 
the Masonic Fraternity. He was Mayor of Rahway from 1866 to 68, a 
member of the first Board of Water Commissioners and represented 
his county in the legislature, being elected to the Assembly in 1868, 
1869 and 1884. In his death. Rahway lost one of its oldest and best- 
icnown citizens. For over forty years he was prominent not only in 
the ranks of his profession but also in every public movement for the 
advancement of the city's best interests. 



ANDREW MANNING, M.D. 

BY T. H. TOMLINSON, M.D., PLAINFIELD, N. J. 

Dr. Andrew Manning was born near Plainfield, N. J., January 6, 
f 861, on the farm on which his father now lives, it having been in the 
possession of the family over two hundred years and being part of 
the original tract chartered to the Mannings by Queen Elizabeth. He 
was the only son of Joel D. and Emeline Townsend Manning, who 
are of English ancestry. 

After finishing his preliminary education at Rutgers College, he 
entered the College of Physicians and Surgeons, New York city, 
under the preceptorship of the late Dr. Burlingham. In May, 1883, 
upon the completion of his medical course, he was appointed on the 
resident staff of Charity Hospital. In 1886 he began the practice of 
JTiedicine in Plainfield and was -soon after appointed city physician. 



382 MEDICAL SOCIETY OF NEW JERSKY. 

In 1891 he was stricken with hemiplegia, the effects of which com- 
pelled him to relinquish his professional duties for two and one-half 
years. Health being restored he resumed practice but devoted most 
of his time to life insurance examinations. On the evening of May 
19, 1898, he was suddenly seized with cerebral hemorrhage and died 
in about one hour. On June 27, 1894, Dr. Manning was married to 
Aretta Hetfield, who survives him. He also leaves a daughter two 
years old. 

At a special meeting of the Medical Society of the County of 
Union, the following testimonial was adopted : 

Whereas. This Society has learned with profound sorrow of the 
death of one of its members, Dr. Andrew Manning ; therefore 

Resolved, That while we bow with submission to the wisdom which 
is beyond our understanding, we deeply deplore the death of our 
beloved and respected fellow-member and desire to express our appre- 
ciation of his sterling worth as a modest, conscientious and scientific 
practitioner of the healing art. 



REPORTS 



OF 



DISTRICT SOCIETIES 



REPORTS OF DISTRICT SOCIETIES. 



ATLANTIC COUNTY. 
To the Chairman of the Standing Committee^ &c.: 

The Atlantic County Medical Society has held its 
meetings regularly throughout the year and these have 
been fairly well attended. The most practical feature of 
the work done has been the discussion of cases occurring 
in actual practice. These have lent real interest to the 
meetings of the society. At the May gathering the Presi- 
dent's annual address was delivered. This took the form 
of an admirable paper on the treatment of phthisis, which 
elicited free discussion on the part of those present. 

The following names have been added to the regular 
membership: Drs. A. B. Shimer, J. W. Snowball, C. R* 
Johnson, W. B. Fayerman and Sharp. No deaths have 
occurred in the society. The officers elected at the 
annual meeting in March, were : President, W. B. Stew- 
art; Vice-President, H. C. James, of May's Landing; 
Secretary and Treasurer, Walter Reynolds; Reporter, 
Wm. Edgar Darnall. 

Dr. Boysen reports an outbreak of measles at Egg 
Harbor City. No other epidemics have occurred except 
mumps of a mild character in Atlantic City, and these 
cases have not been sick enough to need the attention of 
a physician. 

It has been impossible to get statistics by which the 
death-rate throughout the county might be arrived at. 
That of Atlantic City continues phenomenally low. In- 
deed, for the year ending April i, 1898, even last year's 
record has been broken. The figures are as follows : 
Still births, 23; premature births, 20; violence, 18; zy- 






386 MEDICAL SOCIETY OF NEW JERSEY. 

motic disease, 8; miscellaneous, 134; total, 203. Among 
a population of 23,000 souls this gives a death-rate of 
8.82 per 1,000 inhabitants. The total number of deaths 
from all kinds of zymotic diseases were but eight, or 3.2 
to 10,000. Excluding now the still births, premature 
births and those deaths due to violence — a total of sixty- 
one, there is left 142, or a rate of 6.1 per 1,000 inhabit- 
ants, representing deaths due to disease alone. Such 
figures, so far as is known, are unequalled by any other 
city of its size in the world. They give Atlantic City a 
prestige as a health resort which is unique. 

This report should not be closed without some mention 
of the success of the Academy of Medicine of Atlantic 
City, which has just rounded out its first year of exist- 
ence. The meetings have been attended with a degree 
of sociability and have promoted a cordial feeling of 
fraternity among the members that is refreshing to see. 
Cases have been presented and subjects discussed with 
interest and edification. The academy has also enter- 
tained, from time to time, members of the profession from 
other places, whose addresses have been heard with 
pleasure. Among these may be mentioned Dr. Judson 
Daland, of Philadelphia; Prof. John Giflord, of Prince- 
ton, a prominent member of the State Forester Associa- 
tion, and* Dr. C. L. Leonard, of the Pepper Laboratory, 
whose demonstration of skiagraphy was much enjoyed. 

WILLIAM EDGAR DARNALL, Reporter. 
Atlantic City, N. J., June 2, 1898. 



Pneumonia and Abortion. 

BY J. A. JOY, M.D., ATLANTIC CITY, N. J. 

Mrs. P., during the second stage of a very severe attack of pleuro- 
pneumonia, was threatened with abortion. Large doses of morphia, 
even as much as two grains during the whole night, were adminis- 



REPORTS OF DISTRICT SOCIETIES. 387 

tered. But in spite of this she was delivered of a seven months child. 
The labor was easy but the patient very much exhausted. Hypoder- 
mics of the sulphate of strychnine were administered at frequent 
intervals thereafter, for the next four days, with the free use of whiskey 
by the mouth. Rapid and uninterrupted recovery took place in about 
four weeks. The child only lived three hours. This case emphasizes 
the value of strychnine in pneumonia, where it is really the " sheet 
anchor." It is also remarkable that the uterine muscle should resist 
such large doses of morphia. 



Hydrophobia. 

BY WILLIAM EDGAR DARNALL. M.D., ATLANTIC CITY, N. J. 

Inasmuch as many eminent men in the profession are disposed to 
doubt the existence of hydrophobia as a disease and explain the 
violent symptoms as a result of the physical condition of the dread 
and worry, I offer the following case for what it is worth : 

Wm. J., colored, aged 23, well-built and strong, never sick a day in 
his life before. During July last, he was employed as keeper of the 
city dog pound, and was bitten once or twice on the arms and once 
on the leg. During the morning of October 27th, he was taken sick. 
There were occasional attacks of gagging and vomiting but no other 
symptoms, except a mild constipation. He was first seen by me at 
1.30 a. m. on the 28th. The gagging was present, but with an 
unnatural kind of noise for this sort of thing. He had no pain any- 
where, no nausea nor elevated temperature ; pulse was normal but 
with rather excited action. He complained of being a little giddy if 
he stood up. He said his hands were numb. Occasionally was 
noticed a spasmodic action of the breathing muscles, very similar to 
that seen in children when subsiding from a fit of sobbing, and at 
such times the breath came in short jerks. Later he became quite 
noisy with it and would actually shout at times. He was much 
excited about himself and pleaded with me to do something for him. I 
learned that his friends had of late been discussing the question of 
hydrophobia quite freely in his presence. I accordingly thought that 
he had, perhaps, worked himself up to this nervous pitch under the 
influence of fear, especially as all the symptoms present at this time 
were capable of being explained by nervpusness. I confess I was 
not, however, without some forebodings regarding him, but knowing 
the superstition of the negro I tried to laugh his fears away. 



388 MEDICAL SOCIETY OF NEW JERSEY. 

The scars from the dog bites he said were cauterized at the time. 
Now they were in a perfectly healthy condition and free from pain. He 
said he was dying for a drink of water but could not swallow it. He 
did, however, swallow the medicine without much difficulty. At 7.00 
a. m. the patient was still more excited and noisy. The spasmodic 
attacks of breathing were more frequent and intensified. Expectora- 
tion was more profuse than formerly and thick and ropy. He would 
laugh and cry by turns as he begged me to relieve him. He also 
thought somebody " had put a spell on him," and said he was going 
to a voodoo doctor to have it taken off. An attempt to drink some 
water now caused him to clutch at his throat, as with a contortioi> 
and a wry face he squirted it from his mouth. While very much 
frightened about himself he was yet perfectly sane and sensible in his 
conversation, and during these intermissions would remain quiet 
enough. Now and then, as a part of the general spasm of the respira- 
tory muscles, there would be a sharp snap of the teeth together and a 
blink of the eyes. He did not, however, try to injure himself or any- 
one else by biting. At twelve o'clock his condition was aggravated 
in every respect, yet from first to last he never complained of any 
pain, not even a headache, and had no fever. Between paroxysms he 
was in his right mind and fully competent to describe his sensations. 
Expectoration was now very frequent. The expression of his eyes 
was one of wild fear and dread. An attempt to drink water at this- 
time caused an intense and indescribable contortion. So violent was it 
that from a supine position he leapt clear from the bed out on the 
floor with a horrible grimace and flung the water from him. After 
quieting him down we left the house. 

Not long after this he became so unmanageable that the patrol had 
to be called and he was placed in a cell at the police station. At 4.cx> 
p. m. he was visited. He fully recognized those about him, and when- 
he could be quieted would talk sanely enough. The spasmodic action- 
of the breathing muscles was also' somewhat mitigated but his mind 
labored under delusions which constantly changed from one thing to 
another. First, the unfaithfulness of his wife ; the plots of people to 
undermine him ; then attempts of people to poison- or kill him ; now 
under another voodoo spell, and now charging that he had been- 
castrated. Rolling and tumbling about in his cell, expectorating ten 
to fifteen times a minute, he seemed perfectly frantic with anger as- 
his maniacal eyes gleamed through the bars with the frenzy of his- 



REPORTS OF DISTRICT SOCIETIES. 389 

condition. The delirium and delusions of the latter stages of hydro- 
phobia are described as being very similar to those of acute mania, 
except that the intervals are lucid, as was seen in this case, while in 
mania there are no lucid intervals. It is also not an uncommon thing 
for the spasmodic stage to pass into this stage, characterized by all 
kinds of delusions and hallucinations. 

The condition of this man at 8.30 p. m. was fearful. Expectoration 
was now bloody, tenacious and very frequent. He raved and cursed 
and swore obscenely at everything and everybody. Throughout the 
horrible night did this continue, until nine o'clock the following morning; 
when his death occurred, not from respiratory spasm but from sheer 
exhaustion. It is to be noted that even fifteen minutes before his- 
death he had a short conversation with the jailor which was sensible- 
enough. Neither chloral, bromides nor morphine had the slightest 
effect in controlling the paroxysms, although administered in fulE 
doses. An attempt was made to give chloroform, but it seemed t» 
irritate his throat to such an extent that he became too unmanageable 
for it to succeed. 

Brain. — The post-mortem revealed a considerable congestion of 
the arochnoid; a small clot in this membrane at the base of the 
cerebellum but no congestion of the cortex of the brain. There was 
an effusion in each lateral ventricle but not enough, it is presumed, to 
■exert any pressure. Beyond this the organ appeared entirely normaU 

Heart, — The coronary arteries were distended. In the right and 
left ventricles were found " chichen fat " clots, showing progressive 
heart failure. 

Lungs.— 'Y\it. pleura contained some fluid. Both lungs were greatly- 
congested. The lung tissue, however, floated in water. 

Stomach. — About the cardiac orifice was some congestion, while 
two inches from it was found a patch of hemorrhagic extravasatiorv 
into the mucous membrane, fully an inch an a half long. Otherwise, 
the stomach was normal. 

Kidneys. — These were slightly, congested. The bladder was full p 
the liver and spleen were normal. 

It is unfortunate that no history could be obtained of the dogs 
which bit the patient and that no facilities for bacteriological experi- 
ment were at hand. The case is chiefly interesting from the fact that 
eminent medical authorities differ so widely in their ideas regarding 
this malady. There, no doubt, is a condition of pseudo hydrophobiJk 

S5 



390 MEDICAL SOCIETY OF NEW JtRSEY. 

brought on by dread and apprehension, and this is the hydrophobia 
most often seen. It is true that it resembles what has been termed 
true hydrophobia so accurately in detail that often it is well-nigh im- 
possible to distinguish between them. Those cases reported as 
recovering from hydrophobia are thought by Flint and others to be 
of this nature. They also may last from ten days to two weeks, 
while no case of hydrophobia has been known to last over five days. 
This is mentioned even as a diagnostic point. 

The accuracy with which the symptoms of this patient follow what is 
known as hydrophobia, the intensity of it all and the fact that the 
patient, an unusually strong and robust man, died within forty-eight 
hours of the onset of the first symptoms, would lead us to believe this 
a case of true hydrophobia. To those who do not credit the existence 
of such a disease the manifestations of this case must be attributed to 
a purely physical state. Could a man simply from fear of this malady 
work himself up to such a mental condition, productive of meningitis, 
with the delirium delusions, convulsive attacks and hallucinations that 
were present ? These symptoms, in the absence of abnormal tempera- 
ture or any pain, cannot be attributed to any infectious disease accom- 
panied by delirium, or to acute mania. Besides this, some of the 
symptoms which dwell with peculiar emphasis in the minds of the 
laity were not present at all, while others were present which would 
have been absent or forgotten in a case of simulation.' At best, the 
disease is but dimly understood. With so little pathology it seems 
hardly possible such violent manifestations should occur, resulting in 
death in so short a time. Its etiology and bacteriology are also in a 
maze of uncertainty, and the clinical evidence of the case is the only 
thing left us to fall back upon. ' If this case is not hydrophobia, what 
is it ? It fits the description of no other condition or disease that I 
have been able to find in medical literature. 



BURLINGTON COUNTY. 

To the Chairman of the Standing Committee^ &c,: 

The chronic inability of the average physician to put 
his pen to paper is well shown by the fact that only three 
replies have been received to the inquiries issued by the 
Standing Committee through your reporter. 



REPORTS OF DISTRICT SOCIETIES. 39I 

Our society contains twenty-nine members — active, 
intelligent physicians. They have, in all probability, met 
many interesting cases during the year whose recoid 
would be of value, but only one has reported any such 
case. They all probably have very definite ideas on the 
power of milk to propagate infectious diseases, but ail 
except one have carefully concealed whatever thoughts 
they may have on the subject. If, under these circum- 
stances, the report contains little that is of value, your 
reporter does not feel that the responsibility is entirely 
on him. 

Dr. Francis S. Janney reports a case of growth of the 
size of a walnut on the lower plate of the left orbit, dis- 
placing the eye-ball upward, with accompanying diplopia. 
The case was sent for operation, and the question arose 
whether it was a sarcoma or a gumma. As a test she 
was put on potassium iodide in full doses. In a week 
there was a marked diminution in the growth and the 
diagnosis was then made of gumma, although no history 
of syphilis was obtained. Under the continued use of 
the iodide it has entirely disappeared. Dr. Janney also 
reports two cases of purpuric rheumatism, one in a child 
of five years and one in a baby of ten months. 

The general health of the county seems to have been 
good during the past year; no severe epidemics. Dr. 
Reeve, of Medford, reports measles in a mild form. 
Diphtheria has been much less prevalent than in former 
years. 

There have been no deaths among our members. No 
instance has been reported in which milk has been the 
apparent vehicle of contagion, though Dr. Reeve re- 
marked that he has '* full faith in its ability to convey 
typhoid fever." 

The most notable event at our meetings during the 



392 MEDICAL SOCIETY OF NEW JERSEY. 

year was the celebration of the fiftieth anniversary of 
the entrance of Dr. Franklin Gauntt, of Burlington, into 
the society. A complimentary dinner was tendered him 
by the society, at which almost the entire membership 
were present, as well as visitors from Camden and Phila- 
delphia. As Dr. Gauntt was President of the State 
Society in 1872, this event is of interest beyond the 
borders of the county. 

JOSEPH STOKES, Reporter. 



CAMDEN COUNTY. 

To the Chairman of the Standing Committee^ &c.: 

During the year just ended the Camden District 
Medical Society has added another day for meeting 
together. Before this year three meetings annually were 
all that were deemed necessary — one in May for business, 
one in February for pleasure and social intercourse, and 
the other in November for the discussion of prepared 
papers pertaining to our profession. This arrangement 
was not satisfactory to the members; many desired 
another meeting-day for discussion. As neither the 
May meeting for business nor the February meeting 
for social intercourse could be given up, another day was 
added, so that now we have business meeting in May^ 
social meeting in February and discussion meetings in 
October and December. 

The papers presented in the society during the year 
have been interesting and instructive, and have given the 
listening members much food for future thought. The 
members of the society throughout the county have had 
a number of interesting cases, some of which are here 
given. 



REPORTS OF DISTRICT SOCIETIES. 393 

Dr. C. H. Shivers, of Haddonfield, gives the following 
interesting case: '* About Christmas I saw F. W., of 
Kirkwood, N. J., a deaf mute, age 30 years, who had 
wrenched his abdomen in lifting a heater and complained 
of extreme tenderness in the right iliac fossa ; was costive ; 
had nausea and pain ; had also rigors and high tempera- 
ture, with great redness and soreness of the tonsils and 
pharynx and larynx. There was a distressing cough and 
headache. Diagnosed case as * la grippe,* complicating 
appendicitis; gave hourly doses of calomel followed by 
salines; poulticed belly; gave broth diet until free pur- 
gation, then milk and milk punch. The Ma grippe' 
heart demanded strychnia. After four days the cough, 
rapid pulse, loss of appetite and exhaustion seemed to 
be the alarming symptoms, but there was still soreness in 
the lower right belly. As the * la grippe ' subsided he 
complained greatly of his back and sciatic nerve, and 
finally I observed bulging under right kidney. He had 
profuse sweats and lost flesh. While Dr. John R. Steven- 
son gave ether I cut through the back muscles below the 
right kidney and emptied an abscess containing in the 
neighborhood of a quart of pus. Introduced a rubber 
drainage tube and kept it there nearly three weeks. He 
made an uneventful recovery. There was no derange- 
ment of the function of the kidneys at any time. A 
probe introduced through the incision went into the right 
iliac fossa." 

Another member of our society sent me the following 
interesting case, but forgot to sign his name: ** An inter- 
esting case came under my observation recently, namely, 
a ten year old boy who had well-developed attacks of 
typhoid fever and scarlatina of a virulent type at one and 
the same time. The rose-colored spots showed plainly 
on the back and abdomen before the scarlatina eruptions 



394 MEDICAL SOCIETY OF NEW JERSEY. 

appeared. As the scarlatina eruptions became more pro- 
nounced the Kose-colored spots became more and more 
obscure, until almost hidden. As the scarlatina eruption 
disappeared and desquamation set in, the rose-colored 
spots reappeared. The patient made a good recovery." 

Dr. W. H. Pratt, of Camden, reports that he had an 
interesting case of chorea in a child nine months of age. 
He gave arsenic in y^ grain doses and symp. of iodide 
of iron in 2 minim, doses, with complete cure. 

Dr. Pratt also reports a case of transverse presentation, 
with prolapsed arm. He performed a podalic version 
unaided and also without an anaesthetic. Both mother 
and child did well. 

Dr. Daniel Stout, of Berlin, says that the sickness in 
his locality has been nothing more than usual. During 
the past few months has had several cases of pneumonia, 
with no deaths. 

Dr. Paul M. Mecray, of Camden, has performed a 
number of interesting surgical operations. Among the 
number he reports the following: Eight amputations; 
recovery in each case. He reports several operations for 
injuries to skull and brain. Among the number are the 
following: An operation for skull fracture, pressure 
symptoms ; clots removed ; recovery. Another operation 
for compound depressed fracture of the skull ; depressed 
parts elevated ; recovery. Still another for compressed 
comminuted depressed fracture; very extensive ; recovery. 
One for compound comminuted depressed fracture, with 
fracture at base of skull ; death. Another for paralysis 
following a bullet wound; he trephined over centre of 
paralyzed area; the patient made good recovery and par- 
alysis disappeared, but patient died six weeks after 
operation, from hemorrhage caused by specula of bone 
perforating a vein. He successfully removed the parotid 
gland for tumor; recovery. 



REPORTS OF DISTRICT SOCIETIES. 395 

Dr. Alexander McAllister, of Camden, reports the fol- 
lowing case: **I was called in consultation by Dr. C. H. 
Jennings, of Merchantville, May 18, 1897, to see Miss 
S. R., aged 76 years; strangulated inguinal hernia of 
fourteen hours duration. The patient was given ether ; 
effort was made to reduce the hernia, but without success. 
I decided to operate at once ; did so and found a large 
portion of gut and omentum, which was replaced after 
releasing constriction ; the opening was closed with silk- 
worm-gut sutures and wound dressed antiseptically. The 
following morning, temperature, 100** F.; pulse, 80; no 
vomiting after operation, although there had been fre- 
quent foecal vomiting before. After twenty-four hours 
the temperature was normal and remained so. There was 
a stitch-hole abscess which soon healed. One month 
after operation a hard rubber truss was placed on her and 
she was allowed to get up. She now does all her own 
work and can walk three miles, and also takes care of a 
small garden. 

Dr. McAlister also reports having treated a child 
twelve days old, with "la grippe" and congested lung, 
which ended in recovery after two weeks illness. 

Dr. Joseph L. Nicholson, of Camden, has had a number 
of interesting surgical cases during the past year. From 
his list he reports amputations of leg, of arm and of fore- 
arm. Operations for hernia, inguinal, femoral and um- 
bilical. Fractured inferior maxilla, requiring wireing. 
Cancer of breast, necessitating removal. Fractured 
patella; nine days before operation, fragments were 
united by wireing. Appendical abscess : evacuation and 
draining ; recovery. Castration, because of degenerated 
testicle. Rectal polypi. Fistula in ano. Bullet wound 
of bladder; cystotomy and draining; recovery. Crochet 
needle in uterus nine months, complicated with pcMc 



396 MEDICAL SOCIETY OF NEW JERSEY. 

abscess ; removed needle, ovaries and tubes ; drained ; 
recovery. 

During the year just past our society has lost two 
members: Henry E. Branin and Orange W. Braymer. 
Their obituary notices have been contributed by Dr, 
E. I-. B. Godfrey. 

In reference to the health of Haddonfield and vicinity, 
Dr. John R. Stevenson writes as follows: ** During the 
past year the health of the people in my vicinity has 
been good. * La grippe * was occasionally seen, but 
the cases were not numerous. Bronchial and pulmonary 
affections were not as frequent as usual and malarial 
diseases were rare. 

** The only serious disease was diphtheria, which oc- 
curred at intervals throughout the year and became 
epidemic in the winter, for the first time in the history of 
Haddonfield. Its type was insidious and malignant.' 
Usually it began as a common cold, with slight increase 
of the pulse, interfering but little with deglutition, and 
showing no signs, except a small patch or patches of 
membrane in the throat. If neglected, in the course of 
three or four days the larynx was closed with membrane, 
or the nerve-centres were overwhelmed with the poison 
and death followed. 

** There were about forty cases during the year, of 
which the adherents of the two medical schools attended 
about equal numbers. The regular physicians, who used 
antitoxin, except in a few of the mildest cases, did not 
lose a patient, while the homceopaths, who did not use it, 
lost ten out of thirteen children. When antitoxin was 
injected promptly and in full doses, the membrane dis- 
appeared in twelve hours — sometimes at once — appar- 
ently returning to health, so that the family could 
tc.i:cely believe that it was diphtheria, and even the 



REPORTS OF DISTRICT SOCIETIES. 397 

doctor would have been in doubt if his diagnosis had not 
been confirmed at the Princeton Bacteriological Labora- 
tory. About the eighth or ninth day, depression fol- 
lowed, marked by a feeble intermittent pulse, which 
speedily disappeared under arterial and general tonics. 

** The first case, early in the year, in a boarding school, 
was proved to have come from Philadelphia. About 
sixty days afterwards, two cases occurred, clearly trace- 
able to this institution, although the greatest precautions 
had been taken. Other cases probably had their origin 
in the same city, where diphtheria was very prevalent. 
Thirteen cases were located in seven houses, eleven of 
which were contracted by inter-communication, although 
the board of health was active and the public school 
board vigilant, closing the schools twice for a temporary 
period. One in my own practice was contracted at 
school and another at church, from a walking case before 
the disease was discovered. In my experience, the per- 
sonal vigilance of the attending physician and his care in 
isolation and disinfection are the best preventives of 
the spread of diphtheria. Quarantining and placarding 
of houses in towns and rural districts have about as 
much value as nailing a horseshoe over the door to keep 
out witches, while it exasperates the victims and depreci- 
ates property. Many persons have no fear of the disease, 
and only an impractical police espionage can prevent 
them from going out of and coming into infected houses. 
Where diphtheria cannot be isolated the patient should 
be removed to a hospital. Towns and townships cannot 
afford this, but a county might establish such a refuge.'* 

Dr. Wills, of Camden, writes that he has seen more 
cases of typhoid fever among the jjoor than usual, and 
reports a very extensive epidemic of measles of a medium 
type, with well-marked symptoms, in his practice during 
the past few months. 



398 MEDICAL SOCIETY OF NEW JERSEY. 

Dr. W. H. Pratt, of Camden, reports having seen a 
number of cases of measles, especially marked with 
croupy symptoms. 

In the practice of Dr. Alexander McAlister there has 
been a number of cases of measles, complicated with 
pneumonia and capillary bronchitis. He also reports 
cases of '* la grippe " which he believes attacks or enters 
the system through the conjunctiva, as well as through 
the air passages and alimentary canal. Several of the 
** la grippe " cases were complicated with jaundice and 
parotitis. In a few cases among children, "la grippe*' 
took on a marked typhoid type. 

Dr. Daniel Strock, of Camden, reports th*at during the 
fall of 1897, enteric fever prevailed extensively in his 
practice, and that at present an epidemic of measles is 
afflicting the community. He notes the usual visitation 
of ** la grippe," attended with various forms of symptoms. 

Dr. E. L. B. Godfrey, of Camden, believes milk is a 
culture medium and that it possesses a capacity to spread 
infectious diseases. 

Dr. John R. Stevenson says: **I have never personally 
known milk to convey any infectious disease. That it is 
a good carrier of bacilli is well known to the careful 
housekeeper who is aware that milk exposed soon be- 
comes tainted with whatever comes within its radius. In 
proportion to the quantity of milk consumed the cases 
of infectious disease caused by it are surprising small. 
The dairyman and the distributor need constant watch- 
fulness." 

Dr. J. L. Nicholson, of Camden, believes milk is a 
good culture medium, but he has had no experience with 
its spreading disease, other than gastro-enteritis of young 
children. 

Dr. Joseph Wills has always been much impressed 



REPORTS OF DISTRICT SOCIETIES, 399 

with the idea that milk is a good culture medium, especi- 
ally for typhoid fever. 

Dr. Alexander McAlistcr says : " I believe milk to be 
a good culture medium. Epidemics of infectious dis* 
eases caused by milk infection are, I believe, quite com- 
mon, namely, scarlatina, typhoid fever, diphtheria and 
throat affections resembling diphtheria. In nearly every 
case where these epidemics occur the cause can usually 
be traced to the farm where the milk is obtained.'* 

The Camden City Dispensary, with its indoor and out- 
door departments, treated over one thousand patients 
and filled fifteen hundred prescriptions monthly during 
the year 1897. The exact figu;-es for the year are 13,558 
patients and 18,182 prescriptions. This institution, during 
the past few years, has been doing an immense amount 
of work, as the following report will show : 

In the year 1892 there were 4,402 patients treated and 
10,171 prescriptions filled. In the year 1893 there were 
6,276 patients treated and 10,536 prescriptions filled. In 
the year 1894 there were 12,984 patients treated and 
13,599 prescriptions filled. In the year 1895 there were 
9,040 patients treated and 10,002 prescriptions filled. In 
the year 1896 there were 10,138 patients treated and 
12,147 prescriptions filled. In the year 1897 there were 
13,558 patients treated and 18,182 prescriptions filled. 

The eighth annual commencement of the New Jersey 
Training School for Nurses, of Camden, N. J., was held 
May 27, 1898, at which time nine graduates received the 
degree of M.S.N. The address to the graduates was 
delivered by Dr. Joseph S. Baer, of Camden. During 
the year just ended Drs. Paul Mecray and E. A. Y. Schel- 
linger were admitted to the faculty. 

The Cooper Hospital, of Camden, admitted to its 
wards and treated 575 patients in the year 1897. In the 



4CX> MEDICAL SOCIETY OF NEW JERSEY. 

year 1896, 616 patients were admitted and treated. While 
there was a decrease in the number of treated patients 
for the year 1897, yet the average 'stay of each patient 
was longer than for the year 1896. In the year 1896 the 
average stay of each patient was 18.10 days, and in the 
year 1897 the average stay was 22.55 days. 

In the out-patient department of. the Cooper Hospital 
3,378 cases were treated, with 7,698 revisits during the 
year 1896. During the year 1897 the number of cases 
treated were 3,526, with 8,628 revisits. 

The record of the patients treated in the Cooper Hos- 
pital for the year ending December 31, 1897, is as follows: 
Number of cases in. the wards January i, 1897, 38; ad- 
mitted during the year, 537; total, 575. Discharged 
cured, 359; discharged improved, hi; discharged not 
improved, 5; left without permission, 12; died, 56; re- 
maining in the wards January 1, 1898, 32; total, 575. 
The number of patients who died within forty-eight 
hours and hopeless when admitted, 27. 

During the year 1896, the record was as follows: 
Number of patients in the wards January i, 1896, 30; 
admitted during the year, 586; total, 616. Discharged 
cured, 441; discharged improved, 72; discharged not 
improved, 13; left without permission, 7; died, 45; re- 
maining in the wards January i, 1897, 38; total, 616. 
The number of patients who died within forty-eight 
hours and hopeless when admitted, 20. 

During our annual meeting, held May 10, 1898, at 
Blackwood, a large tablet of brass, 3 ft. 6 in. by 4 ft. 6 in., 
artistically engraved and mounted on polished slate, was 
presented to the Board of Chosen Freeholders of Camden 
County, by this society, in commemoration of the dis- 
tinguished services rendered by Dr. Joseph W. McCul- 
lough and Dr. Henry E. Branin during an. epidemic of 



REPORTS OF DISTRICT SOCIETIES. 4OI 

typhus fever at the Almshouse, in the winter of 1880-81. 
The presentation speech, made by Dr. E. L. B. 
Godfrey, was as follows: 

Mr, Presidini, Members of the Board of Chosen Freeholders and of 
this Society^ and Ladies and Gentlemen :■ 

I am honored today with the privilege of presenting to the authori- 
ties of Camden County, on behalf of the Camden County Medical 
Society, a tablet of endearing metai, engraved in commemoration of 
the distinguished services of Doctors Joseph W. McCullough and 
Henry E. Branin rendered during the epidemic of typhus fever in the 
Camden County Almshouse, from November 24, 1880, to April 9, 
1 88 1, a period of nearly six months. The history of this epidemic in 
point of its intensity, its duration and the number infected, is without 
parallel in comparison with any similar fever in West Jersey. Begin- 
ning late in the fall, when malarial affections are prevalent, the first 
chill of this fatal malady occasioned the greatest alarm, especially 
since there were no provisions at the almshouse for the separation of 
the sick from the well. As soon as the deadly manifestations of the 
dreaded typhus became marked, the quick diagnostic abilities of the 
skilled physicians detected its fatal significance. The almshouse com- 
mittee, especially Hon. Louis T. Devousse and Mr. Thomas Wentz, 
rendered efficient service. The Board of Chosen Freeholders was 
summoned ; experts were called, including Professors William Pepper, 
James Tyson and Henry F. Formad, of the University of Pennsyl- 
vania, Doctors Ezra M. Hunt, Franklin Gauntt and Professor Brackett, 
of the New Jersey State Board of Health, and every official and pro- 
fessional energy was invoked to stay the mad progress of the fever. 

The plans for the new hospital building then in course of construc- 
tion were hastened to completion to admit of the segregation of infected 
cases. But the extremely cold weather, the crowding together of 275 
people in the old building, the bad ventilation, the lack of sufficient 
room and appliances for thorough disinfection, and the absence of 
trained and experienced nurses ; all these combined conditions so 
highly favored the spread of the disease that it became a most formid- 
able antagonist. Before the fever could be brought within bounds, Mr. 
Isaac P. Wilson, the superintendent, his two assistants, Jesse King 
and Richard Pike, the assistant matron, Mrs. Pike, Mr. E. A. Ward, 
the contractor and builder, and Dr. Joseph W. McCullough, the 
physician in charge, succumbed to its deadly ravages. 



402 MEDICAL SOCIETY OF NEW JERSEY. 

During this trying time the local clergymen. Rev. Dr. F. R. Brace 
and Rev. J. B. Westcott, faithfully and continuously ministered to the 
sick and dying with a zeal and courage worthy of their sacred calling. 
Of the 275 inmates of the almshouse, 103 were attacked with the 
fever, seventy of whom recovered and thirty-three died, making a 
death-rate of thirty-two per cent. This death-rate is apparently 
excessive, and yet when compared with the historic epidemics of the 
fever at Glasgow and Greenock, in Scotland, it is not excessive, since 
an analysis compiled from the report of this epidemic by Dr. Branin, 
printed in the Transaction of the Medical Society of New Jersey for 
J 88 1, shows that two-thirds of the deaths occurred in people between 
the ages of fifty and eighty, while the death-rate between the ages of 
twenty and thirty was only nine per cent. Typhus fever is the most 
highly contagious of febrile infections. Doctors and nurses in con- 
stant attendance upon the disease are almost invariably attacked, 
especially when the fever is treated in confined quarters, and the 
history of medicine shows that there is no disease which has found so 
many victims in our profession in proportion to its ravages. 

The death of Dr. McCuUough occurred on March 15, 1881, five 
months after the outbreak of the epidemic and one month before its 
close. He was succeeded by Dr. Joseph E. Hurff who nobly filled his 
place during the remainder of the epidemic and has held that position 
from that time until today. Dr. McCuUough was a native of Dela- 
ware and served in the army of the Potomac during the Civil War as 
Major and Surgeon of the First Delaware Regiment. He brought to 
his professional position at the almshouse a courage and an experience 
developed by the dangers and demands of many battlefields, whk:h 
enabled him to face with coolness and skill the greater dangers 
of pestilence. In the death of Dr. McCuUough, the medical profes- 
sion of Camden County lost one of its brightest members. His death 
illustrates, in a degree never equalled, a devotion to professional duty. 
He recognized the personal danger of typhus infection, he appreciated 
the loss of physical strength due to the increasing demands made 
upon him in the five months of service during the epidemic, but not- 
withstanding the risk, his loyalty to his profession and to his position 
impelled him to remain steadfast at his post, against the earnest 
remonstrances of his family and his friends. He died a martyr's death, 
and on the marble that marks his resting place in the cemetery of 
Blackwood, there is carved this glorious inscription : 

" He died at his post." 



REPORTS OF DISTRICT SOCIETIES. 403 

In the pathetic verse of the poet, George Croly, 

'* He perished but his wreath was won, 
He perished in the height of fame." 

Not less deserving of praise was the conduct of Dr. Branin during 
this epidemic. With a fortitude, a self-sacrifice and a loyalty to duty 
equal in every respect to that displayed by Dr. McCullough, Dr. 
Branin, though fortunate enough to escape death, sacrificed his health, 
in a measure, for the remainder of hb life. A native Jerseyman, he 
inherited that spirit of loyalty to principle that has made the 
historic names of Trenton, Princeton and Monmouth forever famous. 
He was graduated from Jefferson Medical College of Philadelphia in 
1858; became a member of the Camden County Medical Society in 
]86o, and its President in 1862. He was a member of the Medical 
Society of New Jersey, the New Jersey Sanitary Association and the 
American Medical Association. In Juue, 1880, he was elected 
Medical Director of the Camden County Insane Asylum, which posi- 
tion he held until his death in May. 1897. The confidence of the 
public in his character was evidenced by his election to the office of 
Trustee of the Blackwood Public School for thirty-seven successive 
years. 

In reviewing the history of these two physicians in connection with 
this institution in which we meet today as the guests of the Honorable 
Board of Chosen Freeholders, I here proclaim, without fear of contra- 
diction, that their conduct throughout the deadly epidemic displayed a 
self-sacrifice, an unfaltering courage and an heroic devotion to duty 
such as has never been surpassed by any public official within the 
domain of New Jersey. Rarely, indeed, have the public services of 
physicians been perpetuated either in monuments of endearing marble 
or tablets of imperishable brass. But we have met today, in the place 
where the event we celebrate occurred, to erect a tablet embellished 
with an inscription expressive of our respect and admiration for the 
skill, heroism and self-sacrifice these physicians continuously displayed 
during the epidemic of eighteen years ago. We erect this tablet with 
willing hands in honor of their distinguished services. The Honor- 
able Board of Chosen Freeholders of this county and the residents of 
Blackwood, whose public interests these physicians so devotedly 
served, unite with us in commemorating the labors of Doctors 
McCullough and Branin, and in proclaiming with one accord, *' Well 
done, thou good and faithful servants." 



404 MEDICAL SOCIETY OF NEW JERSEY. 

We admire the soldier who, like Sheridan at Winchester, turns 
defeat into victory by personal powers and skillful direction ; we 
applaud the sailor who, like Dewey at the Philipines, braves the dual 
dangers of unfriendly waters and a hostile fleet, to bring new glory 
and honor to the Stars and Stripes ; we praise the statesman who, 
like McKinley, for humanity's sake will succor an outraged people 
and rid them from Spanish oppression. But tell me, can you find any 
instance in American history where skillful direction, personal bravery 
and love of humanity shine forth more clearly than in the personal^ 
individual and continuous work of Doctors McCuUough and Branin 
during the epidemic ? Heroes in the public service in times of great 
national excitement enkindle a patriotic love in the heaits of the 
people, and history delights to adore and perpetuate their memory. 
But in the private walks of life, and in the case of the distinguished 
physicians in honor of whose memory we have met today, there was 
neither the glory of " grim-visaged war " nor the "applause of listen- 
ing senates " to urge them to duty, but alike in the busy daytime and 
in the silent night-watches they battled with the unseen forces of death 
and won a triumphant victory. 

All honor to the one who fell fighting at his post, for 

" How can a man die better 
Than facing fearful odds? 

All honor to the one who survived the battle with wounded health 
and continued in the public service until mustered out by the inexor- 
able law of mortality ! 1 now have the honor to unveil this beautiful 
memorial, whose inscription proclaims to all the world that 

This Tablet commemorates the services of 
Dr. Joseph Wesley McCullough 

and 

Dr. Henry Ely Branin 

During an epidemic of Typhus Fever in the 

Camden County Almshouse, 

From November 34, 1880, to April 9, 1881, when there occurred 103 cases with 33. 

deaths, including that of Dr. McCullough. 
The history of the Medical Profession of this county affords no greater instance 
of unfaltering courage and heroic devotion to duty than was exhibited by these 
public servants during this epidemic. 

Erected by 

THE district MEDICAL SOCIETY OF THE COUNTY OF 
CAMDEN, NEW JERSEY, 

May zo. 1898. 



REPORTS OF DISTRICT SOCIETIES. 405 

On behalf of the Camden County Medical Society I have the honor^ 
Mr. Director and members of the Honorable Board of Chosen Free- 
holders of Camden County, to present to you this tablet, to be erected 
in this institution as a fitting testimonial of the public services 
rendered by Doctors McCuUough and Branin. Accept it as the 
tribute which this society offers to complete the measure of their 
fame, and let it be our united privilege to bind the laurel wreath of our 
regard upon their honored brows and •• Send them crowned to history." 

The Hon. Henry F. Wolfe, Director of the Board of 
Chosen Freeholders, accepted the gift on behalf of the 
Board in a few well-chosen and heartily received remarks^ 
He congratulated the members of the society on this ex- 
pression of appreciation of the public services of Drs., 
McCullough and Branin, and spoke feelingly of the 
heroism so frequently displayed by the members of the 
medical profession, without hope of reward and often 
without the acknowledgment so richly deserved. He 
promised that the Board of Chosen Freeholders, in ac- 
cepting the tablet, would value, cherish and care for it 
because of the historic circumstances that led to its 
erection, the nobility of purpose displayed by Drs. 
McCullough and Branin, and their high appreciation of 
the donors. 

Immediately following the presentation and acceptance 
of the memorial tablet, speeches were made by men 
prominent in public life and medical circles. Among the 
latter were Drs. Franklin Gauntt, of Burlington, N. J.^ 
and James Tyson, Professor of Clinical Medicine, Uni- 
versity of Pennsylvania. Prof. Tyson spoke as follows; 

Mr. President^ Ladies and Gentlemen : 

Two or three thoughts are suggested by an occasion like the 
present. In the first place, the fate of the worthy men in whose 
honor and memory we are gathered today, is only one of the 
many events which are constantly arising to attest the risks that are 

26 



406 MEDICAL SOCIETY OF NEW JERSEY. 

actually and yet unostentatiously assumed by the men who enter the 
ranks of our profession. It is as much a part of our creed to be 
modest in allusion to our work as it is to be willing, without fear, to 
encounter the dangers which beset us in the treatment of such epi* 
demies as that which prevailed in the Camden County Almshouse in 
1880 and 1881. We may, however, be permitted in a gathering com- 
posed only of our own number, allude to matters in a manner which 
might appear unseemly in a mixed audience; in other words, to 
indulge in a 4ittle self-praise. We are met to perpetuate, by a simple 
tablet, the memory of these brave men who silently, without pomp or 
pageant or cheering of their fellows, marched to their death on a 
mission whose object was lo save life, and not to destroy it. Their 
enemy was subtler than the wary Indian planting his arrows from 
hidden ambush. Those who fell were quietly interred ; those who 
survived received no decoration or vote of thanks ; they asked none. 
The expectation of reward would not have stimulated their efforts. 
They simply did their duty. 

How different with the victims and the victors of the sword. 
Monuments to the former; thanks and decorations to the latter. Yet 
I am sure that you agree with me in feeling no disappointment, no 
heart burning at this ordering of affairs. This philosophical tendency 
of the studies which go to make up the science of medicine, early 
impresses the student and teaches him to look with indifference on 
matters he knows cannot affect his personal future, let it be what 
it may. 

The second thought which is impressed upon us by this and like 
epidemics of typhus fever, is that which grows out of the inability to 
take any special protective measures against the contagion of this 
fatal malady. It is almost the only one remaining of the infectious 
diseases the precise cause of which has as yet thoroughly eluded us. 
Hence the difficulty in protecting ourselves against it. As I have 
said, if you cannot see your enemy it is impossible to take measures 
to escape him. Hence, it remains only to surround ourselves and 
our helpmates, the nurses, during our intercourse with such an 
epidemic, with common-sense measures to maintain vigorous health, 
such as the proper use of food, bathing, change of air and clothing. 
It is especially important not to remain too long at one time in an 
apartment occupied by patients ill with typhus, and we should be 
watchful of the nurses, who are at a much greater disadvantage than 
ourselves in this respect. 



REPORTS OF DISTRICT SOCIETIES. 407 

The third thought is of the brave and almost reckless pathologist 

who accompanied me to this place seventeen years ago and made the 

autopsies with me on the fatal cases of the disease in which I was so 

much interested. I allude to Dr. Henry K. Formad. He, too, has 

gone to his long home. Dr. Formad's enthusiasm knew no bounds. 

He was constantly, day and night, by reason of his position as 

coroner's physician in Philadelphia, occupied in making autopsies, and 

suffered many times from poison wounds obtained in the line of his 

duty. Yet he recovered from all these and died from an ordinary 

attack of cholera morbus, probably more serious to him on account 

of exhaustion from overwork and anxiety. Reckless as he seemed, 

however, of himself, he was not careless of the safety of others, and 

I remember well the half joking and yet serious remark which he 

made as he finished up the last autopsy on that somewhat memorable 

occasion : " It is best. Professor, that we get out of this as soon as 

possible." Formad had his faults, but they were of the light kind, 

and he had many good traits, while he did much to give morbid 

anatomy the prominent place it now holds in the medical teaching 

of Philadelphia. 

JOHN G. DORON, Refiorter. 
Cami»en, N. J. 



CAPE MAY COUNTY. 

To the Chairman of the Standing Committee ^ &c,: 

Our society, though small, is in a very prosperous con- 
dition, the annual meeting, held at Cape May, April 
14, being well attended. Dr. C. B. Corson, of Seaville, 
read a very interesting paper on the uses of internal and 
external antiseptics, which was followed by a general 
discussion. 

Measles prevailed very generally throughout the county 
during the winter. There have been fewer cases of ** la 
grippe " and typhoid fever than during the previous year. 

Dr. James Mecray, of Cape May, remarks : *' I have 
had, during the past year, seven cases. In five of these 
I used Mulford's antitoxin. The first case, a boy five 



408 MEDICAL SOCIETY OF NEW JERSEY. 

years old, had been sick seven days before I saw him ; he 
died in a few hours. His mother was taken, the day the 
boy died, with a chill and vomiting ; temperature 103 ; 
restless, and throat badly coated with membrane. I 
gave 1,000 units at 10 a. m. At 8 p. m. temperature was 
the same; gave 1,000 more. In the morning, tempera- 
ture 100; same evening, 99; next morning, 98^; in the 
evening, normal. Four other cases were treated in the 
same manner with good results. I also used internal 
remedies and local sprays. The duration of these cases 
was from five to seven days. In two cases in which anti- 
toxin was not used the duration was. from ten to four- 
teen days. The temperature in cases in which antitoxin 
was used did not fall in any case before ten or twelve 
hours; it was then marked and rapid." 

One fatal case, appendicitis, operated on by a surgeoa 
from Philadelphia, died the following day. 

Dr. Marcy, age 70, is now recovering from an attack of 
typhoid fever contracted in Chester, Pa., lasting six 
weeks, of a severe type. 

Dr. Charles B. Corson, of Seaville, writes : ** I met 
with a case of eclampsia in September, 1897, in an 
elderly primiparae, 42 years of age. The pelvis was 
rather contracted and the muscles rigid ; child's head was 
large. Just as head pressed on perineum, patient passed 
into a severe convulsion. By hastening delivery and 
administering chloral and veratrum viride, the convulsions 
were controlled. Patient after this made a good recovery 
Verat. vir. acts very satisfactorily in this condition. 

JOHN S. DOUGLASS, Reporter. 

TUCKAHOE, N. J. 



REPORTS OF DISTRICT SOCIETIES. 409 

CUMBERLAND COUNTY. 

To the Chairman of the Standing Committee^ &c,: 

Out of thirty-five circular letters addressed to the mem- 
bers of our Cumberland County Medical Society, your 
reporter received in return but five responses. This fact 
is not attributed so much to a lack of interest as to 
neglect, since all of the meetings during the year have 
been unusually interesting and well attended. Two can- 
didates have been elected to active membership during 
the year and two to associate membership. 

The principal papers read before the society have been : 
" Serum Therapy/* by Rulon Dare, M.D.; " Some Favor- 
ite Formulae,*' by J. W. Wade, M.D.; ** Old Time Doctor,** 
by J. B. Ware, M.D.; "Puerperal Eclampsia,*' by S. T. 
Day, M.D. 

A few isolated cases of diphtheria and scarlatina have 
been reported in Bridgeton, but no epidemics of any 
moment excepting whooping-cough, which has been 
prevalent throughout the county. In Port Norris, Dr. 
S. T. Day reports that it attacked both old and young, 
causing several deaths among the young. The disease, 
he claims, was brought to them by the Italian straw- 
berry pickers. The principal remedies used in treatment 
were belladonna, bromoform and antipyrine. The best 
results were obtained from antipyrine. 

Four dieaths have been reported in Bridgeton from 
typhoid fever during the year, and two in Millville. 

Dr. M. K. Elmer believes that there are many in- 
stances on record to show the capacity of milk to spread 
infectious diseases. 

Dr. S. M. Snyder, of Greenwich, reports two interesting 
cases in his practice during the year. One, a retained 
glass disk pessary for over thirty years, with subsequent 



410 MEDICAL SOCIETY OF NEW JERSEY. 

utero-vaginal carcinoma and death ; the other, a case of 
pregnancy during chronic Bright's disease, with delivery 
at eighth month, caused by an attack of uraemia. Mother 
and child survived and child is now near three months old. 
Artificial rearing. 

Dr. G. E. Day, of Millville^ reports the following: 
" April 23, normal labor case, second child ; normal puer- 
perium. Made last call on tenth day and found patient up, 
feeling very well. May 6, received call and found pulse 
125, temperature 104; no pain, no localized soreness; 
lochia normal; history of headache on morning of sixth; 
history negative ; no exposure, no fright, no imprudence, 
but worry and grief over a disappointment. Treatment : 
Quinine gr. 2 every hour until ten grains were taken ; also 
salol gr. 3 and acetanilid gr. 2 every hour for five hours. 
In morning, temperature normal ; lochia re-established ; 
pulse normal. Cause, in my opinion, worry and anxiety." 

Dr. S. T. Day, of Port Norris, reports the following 
abstract from his paper, " Puerperal Convulsions ; Pre- 
vention and Treatment ": ** In the prevention of this 
malady I recommend bi-weekly urinalysis during the 
latter months of pregnancy. If premonitory symptoms 
appear, and if the patient is strongly plethoric and an 
attack is imminent, bleed or give an active saline cathartic 
and bland diet ; if anaemic, give mild laxative. Diet 
should be nutritious and non-nitrogenous. The essen- 
tials of prophylaxis are catharsis, diuresis and diaphoresis. 
In the treatment I advised, first, the lance, verat. vir. 
gtt. V. to XV., or chloroform, as the case may require, then 
morphia, chloral or brom. pot. I reported seven cases of 
eclampsia, with two deaths ; both were plethoric persons, 
but bleeding was not resorted to. Of the other five, 
two were mild, each having but one convulsion after 
delivery. Other were severe cases; convulsions 5, 9, 17 



RErORTS OF DISTRICT SOCIETIES. 4 II 

respectively having occurred before delivery. Treatment 
was as above outlined — bleeding, morphia, verat. vir., 
chloral and brom. pot., and delivery under chloroform 
anaesthesia, as indicated.** 

Our society has lost by death during the year, one of 
its associate members, Dr. Theophilus Parvin, of Phila- 
delphia, whose birthplace was Fairfield, and who has 
always had a warm place in the hearts of physicians in 
this county ; also, an honorary member, at one time most 
active in the society, Dr. Jonathan S. Whitaker, whose 

obituary appears elsewhere. 

J. C. APPLEGATE. Reporter. 
Bridgeton, N. J. 



GLOUCESTER COUNTY. 

To the Chairman of the Standing Committee^ &c,: 

It is gratifying to be able to report the flourishing condi- 
tion of our society and great interest taken in it by the 
members. The regular meetings are held bi-monthly, ex- 
cept during the summer months, and are always well 
attended. A number of interesting cases were reported 
during the year. Dr. Laws, of Paulsboro, reported a case 
of labor in a woman, with tubercular history. Breech 
presentation ; body was finally delivered, but head did not 
follow. The pains having given out, ergot was given 
and the pains recommenced. On examination it was 
found that the uterus was unusually large. Firm pres- 
sure upon it was made, when there was a gush and the 
head was discharged, and it was seen that it was a case 
of hydrocephalus which had busted. The brain had 
tubercular patches scattered over it. 

A case was reported of gunshot wound penetrating the 
chest between seventh and eighth ribs in the axillary 



4X2 MEDICAL SOCIETY OF NEW JERSEY. 

line. The wound was washed out with an antiseptic 
solution and the chest was strapped with adhesive strips. 
Patient did well for a week when he was suddenly taken 
with . tetanus. Tetanus antitoxin was given but the 
patient died 32 hours after seizure. A case of cystitis 
was also reported by Dr. Laws, which occurred in a man 
of seventy-four years, having enlarged prostrate.. There 
was complete retention, which was relieved with difficulty 
by use of catheter. Pain in the bladder was very severe 
and the urine became ammonical. No remedies seemed 
to do the least good until, finally, the bladder was 
washed out with normal urine, which gave immediate 
relief. 

Dr. Hunter, of Westville, also reported a case of severe 
cystitis in which blood-warm milk was used to wash out 
the bladder, with remarkable success. Dr. Hunter nlso 
reports seven cases of diphtheria, with two deaths. Anti- 
toxin was used in all cases. He believes cases seen early 
and given maximun doses of antitoxin will give a 
mortality much lower than any of the present rates. 

Dr. Wilson, of Woodbury, reported a case of a woman, 
age seventy-three years, who complained of feeling badly. 
No particular trouble was discovered until the next day, 
when he found she had been passing blood from the 
bladder. Her temperature was normal and pulse fair. 
Two sisters having died of cancer he examined for this 
affection but could find no tumor. Ergot, gallic acid and 
turpentine were used, but without effect. One week 
later he found a mass in region of right kidney, which 
was proven to be a malignant growth of the kidney. 
The patient died one week later. 

Dr. Halsey, of Williamstown, reported a very interest- 
ing case seen in consultation. It was a case of labor 
in a woman eighteen years of age. Labor was normal 



REPORTS OF DISTRICT SOCIETIES. 413 

and case did well for a week. He saw her on the 
eleventh day, and temperature at that time was loi®. 
He found gangrenous ulcer of vagina and vulva. There 
had been a large slough involving lower portion of vagina 
and vulva, extending almost to the arms. The breasts were 
affected with the gangrene, also the tonsils and soft 
palate. Dr. Heritage, of Glassboro, reported a case of 
congenital dislocation of both hip joints. Dr. Heritage 
also reports two cases of vomiting of pregnancy in which 
belladoma was used with good results. Dr. Reading, of 
Woodbury, reported a case of abortion in the third week, 
in which the ovum was cast off entire. 

Dr. Stout, of Menonah, reports three cases of typhoid 
fever in which the Woodbridge treatment was used with 
good results. Epidemics of malarial fever, typhoid 
fever, whooping-cough, tonsilitis, scarlet fever, diphtheria, 
measles and influenza were reported during the year. 
Measles proved unusually severe in type, with bronchial 
complications. Influenza, in a number of instances, was 
followed by rheumatism. Drs. Hunter, Laws and Read- 
ing reported cases with a severe supra-orbital neuralgia as 
a feature. 

At the March meeting an interesting and instructive 
address was delivered to the society by Dr. Chas. S. 
Turnbull, of Philadelphia, on the subject of ** Blepharitis, 
its Causes and Treatment ;" also an address by Dr. Shim- 
well, of Philadelphia, on the medical and surgical treat- 
ment of diphtheria. At the May meeting. Dr. H. H. 
Stout, of Menonah, read an essay on ** Acute Catarrhal 
Earache,*' which was eminently practical and instructive. 
At the same meeting Dr. Daland read a paper on " Consti- 
pation, its Diagnosis and Treatment," which was well re- 
ceived. Dr. H. H. Hare also read a paper relating to 
three new therapeutic proceedures, viz., hypodermoclysis 



414 MEDICAL SOCIETY OF NEW JERSEY. 

for toxaemia, particularly uremia ; treatment of aneurism 

by electrolysis, and the use of calcium chloride in oozing 

hemorrhages. It is with deep regret that I report the 

death of one of our most respected members, Dr. H. G. 

Buckingham, of Clayton, a man who was highly honored 

and esteemed in his profession as well as by all who 

knew him. 

WILLIAM BREWER. Reporter. 

Woodbury. N.'J. 



A Case of Tetanus. 

BY WILLIAM BREWER, M.D.. WOODBURY. N. J. 

On the nth day of March I was called to see a young man, 
age 17, who was suffering with tetanic convulsions. His parents gave 
me the following history : That on the 28th day of February, while 
walking through the meadow, he stepped on a sharp alder stubble 
which penetrated the sole of his boot, entering the bottom of his foot 
about a half inch. Using home remedies, such as soaking the foot ir> 
lye and applying flaxseed poultices, etc., the wound was kept open 
discharging pus and blood until the loth day. when it healed. On the 
1 2th day of the injury he complained of stiffness in the back of his 
neck and lumbar region. On the f 3th day he was taken with severe 
tetanic convulsions. I was immediately summoned, and seeing the 
the serious condition in which the young was, I at once gave hin> 
an anaesthetic, chloroform being used for that purpose. I proceeded 
to open the wound ; a free incision was made about three inches long ; 
the wound was curetted by means of a sharp curette and washed with 
1-500 solution of bichloride of mercury. I kept the wound open., 
washing it out every day. 

I gave him twenty grs. of chloral and potassium bromide. I saw 
him again in about two hours. Found his jaws locked, head retracted., 
muscles extremely rigid all over the body and extremities, he being in 
a state of oposthotonos, risus sardonicus well-marked. There was 
severe pain in the region of the diaphragm, convulsions on an average 
of three per mmute, pulse 82. I immediately gave him hypodermic 
injections of carbolic acid, one-eighth of a drop given every two hour;., 
for twenty-four hours. After that only giving him three injections 



REPORTS OF DISTRICT SOCIETIES. 4x5 

a day for three days, together with two drops of tr. veratum viridi 
every two hours for two days and an emulsion of yolk of egg contain- 
ing chloral gr. x., potassium bromide gr. x., deod. tr. opii. gtt. 
by the rectum. My patient took plenty of nourishment — four quarts 
of milk in twenty-four hours. By means of a straw he was able to 
suck the milk between his teeth and in that way was well nourished. 
On the fourth day of the disease he began to improve, muscles 
began to relax, jaws could be opened about one-quarter of an inch, 
convulsions lessened, both in number and severity, having only forty- 
four on the fifth day. Being able to open his jaws a little I discon- 
tinued the rectal injections and continued the bromides, grs. x. and 
chloral, grs. iii., every two hours, by the mouth. The hypodermic 
injections of carbolic acid, increased to one-quarter drop, were 
continued once a day for one week longer. At the expiration of 
that time the convulsions entirely ceased, the muscles relaxed, except 
the sterno-mastoid, which was the last to yield. The young man was 
convalescent in three weeks from the beginning of the attack, able to 
sit up during the fifth week and completely recovered a week later 
with the exception of contraction of the tendo achilles of the leg of the 
affected foot, which was relieved by massage. I attribute the cure of 
this case entirely to the hypodermic injections of carbolic acid, acting 
either as an antiseptic or an antidote to the bacillus of tetanus. 



A Case of Trichinosis. 

BY GEORGE E. READING, M.D., WOODBURY, N. J. 

On December 20, 1897, Mr. E. E. F., aged 32, married, presented 
himself at my office suffering from a pain in the lumbar region, which 
I diagnosed as muscular rheumatism and for which I prescribed soda 
salicylate. On the 22d he again came and reported the pain no better. 
I continued the salicylate and added Dover's powder. The next day 
he was so much worse that he kept his bed and I was sent for. The 
amount of salicylate was increased and in a few days the pain in the 
back subsided, to be followed by similar pains in the intercostal 
muscles, the biceps, the muscles of the thigh and even in the cardiac 
muscles. These attacks pursued the same course as the pain in the 
back, viz., coming on rather suddenly and lasting a week to ten days 
then gradually subsiding, to begin again in some other group of 
muscles after a greater or less interval. In some of the groups of 



4l6 MEDICAL SOCIETY OF NEW JERSEY. 

muscles there was considerable superficial edema. This was particu- 
larly noticeable on the left shoulder and arm, and over the muscles of* 
the left side of the neck. There were, on several occasions, severe 
pain in the ocular muscles, particularly on the left side. 

The course of the case convinced me that my first diagnosis was 
erroneous and I then made a diagnosis of trichinosis and changed the 
treatment accordingly, discontinuing the salicylates and putting the 
patient upon supporting treatment — quinine, strychine and alcoholics, 
and toward the last, digitalis and nitro-glycerine. He seemed to do 
quite well for several weeks in spite of the recurrence Qf the muscular 
pains, but finally sank and died of heart failure on the seventy-fifth 
day, immediately after trying to sit up in bed to fix his pillow. I 
could not obtain any muscular tissue for microscopical examination 
nor any direct evidence, of eating underdone pork. 



HUDSON COUNTY. 
To the Chairman of the Standing Committee^ &€.: 

In preparing my report for this year I am hampered 
somewhat by not having received many replies to the 
interrogatories sent the members of our society, which 
were furnished by your committee. 

From different sections of the county comes good 
reports of the sanitary and hygienic conditions, and all, 
without exception, have nothing but praise for the timely 
introduction of the good and wholesome water spoken of 
in my last year's report. During the last year a number 
of societies have been formed by the medical men resid- 
ing in the county, limited in membership and possessing 
certain rigid rules without which many undesirable mem- 
bers might be associates. They are formed for good, 
sound, professional work, and the character of the meet- 
ings, the attendance and the interest displayed all prove 
the value of such organizations. 

The death-rate has decreased to a notable degree, a 
condition which is hailed with delight by all. The cause 



REPORTS OF DISTRICT SOCIETIES. 417 

of this is owing to improved sanitary conditions and the 
free use of the new water supply. The nuisances of 
which I had reason to speak in my last report are fast 
disappearing from our largely inhabited county, thanks 
to an efficient grand jury, and we hope ere long to be 
entirely rid of all obnoxious manufacturing interests 
which formerly had their seat of operations on our 
nieadows. 

But one epidemic has visited us during the year — that 
of typhoid fever. The disease made its appearance in 
the month of November and became endemic in certain 
districts. The cause of this condition was ascertained to 
have Its origin in the home of the dairyman who supplied 
the local dealers. This dairyman had a case of typhoid 
fever in his family which was communicated to the dairy 
through the water supply and to the milk during the 
process of cooling. The disease was quickly recognized 
by the physicians in charge of the sick, who in turn 
notified the State Board of Health, who at once quaran- 
tined the dairy and thus arrested the further spread 
of the disease. 

It is with profound regret that your reporter is obliged 
to chronicle the death of two of our brightest stars in 
the medical profession — that of Thomas Hanlon Atkin- 
son and Isaac Newton Quimby, both of whom were 
active in the social, political and professional world in 
every sense. The vacancy caused by their removal from 
this sphere of usefulness will be difficult to fill. Their 
obituaries accompany this report. 

I desire to enclose a paper from the pen of Burdette 
P. Craig, M.D., of Jersey City, on " The Artificial Feed- 
ing of Infants." 

Very respectfully, 

J. A. EXTON, Reporter, 
Arlington, N. J., June 10. 



41 8 medical society of new jersey. 

The Artificial Feeding of Infants. 

BY BURDETTE P. CRAIG. M.D., JERSEY CITY. N. J. 

In the domain of pediatrics there is no more important subject than 
the topic I have chosen for consideration. The large number of 
infants who are compelled to receive their nutriment from a source 
other than that provided by nature, makes the subject one worthy of 
our deepest consideration. Upon the proper modification and regula- 
tion of the artificial mixture made use of, depends the prevention of 
the diseases of nutrition and the reduction of a great causative factor 
in the mortality of the first year. 

Cow's milk in some form is so universally employed in the substi- 
tute feeding of infants as to render the discussion of other milks, e. g,^ 
goat's or mare's, unnecessary. The source and purity of the milk 
supply is manifestly of the greatest importance and a most essential 
feature in the management of cases entrusted to our care. To obtain 
a milk suited for our needs, careful inspection must be made of the 
buildings where the cattle are housed and their surroundings, the 
health of the cattle, the care bestowed during the milking process and 
the handling of the milk till received by the consumer. It is within 
the province of the physician to study the detail of the barn-yard, to 
see that a sanitary condition is maintained, and to insist that the 
barns be well ventilated, have plenty of light and good drainage. 
There should be no board partitions between the cows to harbor dirt, 
and manure should be removed as soon as possible to a considerable 
distance from the buildings. 

The cooling house, wash house for utensils and the bams for 

« 

storing fodder, should be separated from the other buildings and 
located at some distance from the cow stables. Bedding clean and 
free from odors, feed of the best quality, and a generous supply of 
good water are essential to the health of the cow. Every day each 
cow should be groomed, and before each milking the udder and teats 
thoroughly cleansed. The milkers, too, must observe rigid cleanli- 
ness, and previous to milking, give their hands and arms a careful 
washing and drying, put on a clean apron to cover their garments, 
and see that the pails used to receive the milk are scrupulously clean. 
The first jets are of poor quality and consequently discarded. The 
milk should be immediately strained, aerated and rapidly cooled down 
to 40® F. or 45° F., and kept at that temperature after bottling until 



REPORTS OF DISTRICT SOCIETIES. 419 

it reaches the consumer. Regular examination of the herd for tuber- 
<:uIosis is a necessity and ought to be made at least twice a year. 
Any cow giving evidence of the disease should be immediately 
slaughtered. 

That these measures are not beyond the possibilities of any city is 
evidenced in the success of "Certified Milk" in Newark, where, 
largely through the efforts of Dr. Coit, there is daily delivered milk of 
remarkably uniform purity. It was the good fortune of the Newark 
<:ommittee to secure the cooperation of an intelligent dairyman, and it 
is gratifying to learn that his business has largely increased and like- 
wise his profits. The example of Newark has been followed in 
Rochester and Buffalo, and in the latter city a marked improvement in 
the general supply has been noted, occasioned by the efforts of other 
milk producers to compete with the " certified " milk. 

That regulation in some such way is demanded, may be well illus- 
trated by a description of two *' brewery grains " dairies I visited 
recently in this county. The two hundred cows were being fed on 
brewery grains and No. 2 fiour, prepared in each shed and supplied to 
the cattle at 2 a. m. and 2 p. m. Hay, apparently of good quality, 
was given twice a day. Milking was performed at midnight and 
noon. The barnyards were filthy with mud and manure, and the 
cows crowded into long, dimly lighted sheds that were saturated with 
odors of brewery grains, ammonia and manure. The cans in which 
the milk is shipped were indiscriminately placed around the yard, and 
some cans containing the product of the last milking were being 
cooled and aerated in a large wooden tank adjoining one of the cow 
sheds. The cows were separated into pairs by board partitions, and 
if one cow was lying down, the other, in its endeavors to do so. would 
fall partly on the recumbent cow and so force her to stand up. Dust 
and cobwebs were largely in evidence, and the drainage exceedingly 
poor. The cattle, however, looked remarkably well, which may be 
accounted for by the fact that nearly all the herd were disposed of in 
the late spring and new stock purchased in the fall. In one place I 
found six cows in a small, dark cellar of the house in which the 
-employees lived. The product of these dairies is sold on the east 
side of New York city and will meet the requirements of the health 
boards. 

Should not such conditions existing in our very midst arouse us to 
see that laws are enforced, that purity of our milk supply is secured ? 



420 



MEDICAL SOCIETY OF NEW JERSEY. 





Cow's Milk, 


Reaction. 


Slightly acid 


Specific gravity 


1030 


Water 


86.50 


Total solids 


13.50 


Fat 


3.50 


Sugar 


4.50 


Proteids 


4. 


Total ash 


.70 



As the brilliant achievements obtained in surgery during the last 
twenty-five years have been the result of antisepsis and asepsis, so I 
believe shall we find the keynote of this other great problem to be 
absolute cleanliness : asepsis in the dairy, during transportation, in the 
milk-shop and in the home. 

But this is only one side of our question. There exists differences 
between woman's and cow's milk, and we must therefore consider the 
latter with a view to making it a substitute for the former. Let us 
contrast the general averages of these two milks. 

Woman* s Milk, 
Slightly alkaline 

1031 

87.50 

12.50 

4. 

7. 
1.50 

.15 

It will be seen that the important differences are in the sugar, pro- 
teids and reaction ; also that the fat is lower in cow's milk than in 
woman's milk, and it is by the proper proportionment of these factors 
that we hope for success in our endeavors to immitate the human 
product. Milk of good quality being a requisite we may determine 
this point by various methods, the simplest and quickest compatible 
with exactness being obtained by the use of the Babcock milk tester 
or the use of the medical centrifuge. Having made frequent use of 
the latter method, a brief description may be of interest : Five c. c. of 
milk is introduced by means of a pipette into the "milk bottle" and 
one c. c. of a solution of fusel oil, wood alcohol and hydrochloric acid 
is added, and the mixture shaken by hand. Sulphuric acid of a 
specific gravity of 1832 is slowly added, occasionally agitating the 
bottle, until the bottle is filled to the neck. The bottle is then placed 
in the centrifuge and whirled for one or two minutes, when the fat 
will rise to the top and can be read off in direct percentages. Dilu- 
tion must be practiced in the case of very rich milk or cream. 

The factors in cow's milk requiring modification and their function 
in nutrition may be briefly referred to. Fat is required for the pro- 
duction and maintainance of body heat, and by its accumulation con- 
tributes an increase of weight. It exercises a laxative action and. 



REPORTS OF DISTRICT SOCIETIES. 42 1 

participates, to some extent, in the growth of the nerves and bones. 
It also aids the proteids by husbanding the nitrogenous waste. There 
is no seeming difference between the fat of woman's and cow's milk. 
We regulate this factor by the employment of cream. The proteids 
are the constructors of tissue, or cell-growth formers. They con- 
tribute the nitrogenous supply solely and have, consequently, a most 
important ofiice when we consider the continuous nitrogenous waste 
that occurs. It will be remembered that the proportion of proteids 
in woman's milk as compared to cow's milk is as 1.5 to 4, or that 
they are doubled or trebled in cow's milk. It is this excessive 
variance, coupled with the greater amount of casein in comparison 
to lact-albumen that exists in cow's milk, which causes much of our 
troubles and disappointments in the artificial feeding of infants. We 
reduce this factor by the use of water or some other form of dilutent. 

Sugar occurs as lactose or milk sugar in both woman's and cow's 
milk. . Its function is the production of heat and fat. It is the most 
abundant of the solid constituents of either milk, but we are required 
to augment the supply when using cow's milk, in order to approximate 
the material percentage. This is done by the use of sugar of milk or 
cane sugar. 'The latter is largely used on account of its cheapness, 
accessibility and the fact that often a good quality of milk sugar is 
hard to obtain. The acidity of cow's milk is counteracted by the 
employment of an alkali, usually lime water or bi-carbonate of soda. 
My preference is for the former, used in the proportion of one to 
sixteen. While ordinary milk gives an acid reaction — and if found to 
be alkaline the presence of some " preservative " may be suspected — 
it is known that cows in the " blue grass " region of Kentucky and 
those pasturing on lands rich in limestone will produce a normally 
alkaline milk. 

Dr. Rotch states that cows fed daily on sugar-beets, at the rate of 
ten pounds per head, will produce an alkaline milk. Bacteria find in 
milk a desirable resting-place and every facility for their multiplication,, 
especially when cleanliness and care in handling is not practiced. 
We have plenty of evidence regarding the capacity of milk as a 
conductor of disease, and epidemics of scarlatina, diphtheria and 
typhoid fever from the use of contaminated milk, have been frequently 
reported. Tuberculosis is often communicated by means of milk 
derived from cattle suffering |from the disease, and GUiver (Abstract 
in " Archives of Pediatrics," Vol. XI., p. 239) reports several inmates 

S7 



422 MEDICAL SOCIETY OF NEW JERSEY. 

of an institution for girls who developed and died of tuberculosis 
where no inheritance could be made out. The cow which supplied 
the milk was killed and found to be tuberculous. 

Cholera infantum, summer diarrhoea and similar intestinal disturb- 
ances are known to be caused by ptomaines produced by bacteria in 
milk. Siebert suggests the filtration of milk through absorbent 
cotton, and claims the bacteria are reduced by seven-eighths without 
affecting the cream, percentage of fat or specific gravity. By this 
means all foreign matter, such as dirt, hair, etc., is effectually removed. 
The cases of milk poisoning that occurred in Jersey City last October 
were of bacterial origin, as was demonstrated by Dr. Krauss, bacteri- 
ologist to the Jersey City Board of Health. In this instance four 
families purchased milk from a grocery store which had obtained its 
supply the day previous. The weather was unduly warm and the 
milk carelessly handled. Six children in three families gave evidences 
of poisoning shortly after drinking the milk, but eventually recovered. 
The family of the other customer was entirely unaffected on account 
of having boiled the milk before using. Dr. Krauss injected two c. c 
of the plain milk into the peritoneal cavity of a young and vigorous 
guinea-pig and produced marked symptoms of poisohing, but the 
animal finally recovered. Two c. c. of the milk boiled was injected in 
the same location in another guinea-pig and without effect. Two c. c. 
of a 24 hour bouillon culture of the mixed bacteria, used in like 
manner on a healthy guinea-pig, caused its death in twelve hours 
with all the symptoms of poisoning. Here, too, the efficacy of boil- 
ing the milk is to be noted, for the family who used this precaution 
was in no way affected, nor was the guinea-pig that received the injec- 
tion of boiled milk. 

This statement naturally directs attention to the sterilization of milk, 
which may be complete or modified. Complete sterilization of milk 
ts produced by the application of heat at 212^ F. for a length of time, 
varying from one to two hours, and is destructive to bacteria and 
spores capable of producing them. Pasteurization or low temperature 
sterilization is accomplished by the application of heat at 167® F. for 
thirty minutes, and while not destructive to spores, it kills the germs 
capable of producing disease. Sterilized milk will keep longer than 
l^asteurized milk and is therefore advocated during summer and for 
use on long journeys, but in the latter case should be sterilized for 
one hour on three consecutive days. It has the objection of having a 



REPORTS OF DISTRICT SOCIETIES. ' 423 

"boiled milk" taste and causing constipation. The casein is made 
harder to digest and in other ways not as yet reliably determined, it 
has some effect on the composition of the milk. These objections do 
not apply to milk sterilized at a low temperature, and thus Pasteuriza- 
tion is the method most frequently advocated. 

For families whose means will permit of its use, the Walker-Gordon 
laboratory offers an excellent and efficient method of milk modifica- 
tion. Here our required percentages are exactly filled in accordance 
with our prescription and the mother or nurse relieved of the labors 
of sterilizing. It partakes of the kodak rule, " You do the judicious 
prescribing and the Walker-Gordon laboratory does the rest," and 
my experience has been that they do it scientifically and well. But 
many of our families cannot afford the employment of laboratory 
milk and we are compelled to arrange some form of home modifica- 
tion for them. The sterilization may be accomplished by using the 
Arnold sterilizer, which can also be used for Pasteurizing, or the 
Pasteurizer of Dr. Freeman employed for the maintainance of a 
temperature of 167^ F. Dr. Seibert has devised a low-priced " Infant 
Feeder," the use of which he advocates with his " weight, not age " 
rule for feeding. It is important to remember that milk sterilized at 
a low temperature should be rapidly cooled and placed on ice so as to 
prolong its keeping qualities and prevent the growth of undeveloped 
germs. 

The modifying materials required are a good 10^, 12^ or 16^ cream, 
according to individual preferment, milk, milk sugar and lime water 
or bi-carbonate of soda. The precaution should be observed of 
making a solution of the sugar previous to its addition to the mixture. 
It is my custom to add the lime water just before feeding in order to 
prevent the precipitation and discoloration that occurs during steriliza- 
tion. It is obvious that the proportions of the modifying factors 
employed must vary with individual cases and the ingredients and 
quantity increased or diminished as circumstances, such as age, 
weight, condition of digestion, etc., warrant. A safe formula for use 
during the first two weeks may be obtained by using 2 ounces each 
of a ten per cent, cream and milk, and 1 5 ounces of lime water, and 
6| drachms of milk sugar. This will furnish ten feedings of two 
ounces each when the lime water has been added. The sugar of milk 
can be measured by means of the sugar measures of Rotch or Griffith, 
or a pound of milk sugar divided into packages containing 3f drachms. 



424 MEDICAL SOCIETY OF NEW JERSEY. 

Certain clinical signs occur which aid us in determining the proper 
proportions to employ, and suggest the possible cause of any disturb* 
ance with digestion. 

The presence of colic, vomiting or curd in the dejections is suggest- 
ive of proteid excess, while its deficiency is productive of evidences of 
general malnutrition, muscular feebleness and anaemia. Frequent 
regurgitation of food in small quantities occurring an hour or two 
after taking the bottle is indicative of too much fat, while its scant 
supply is shown by slow gain in weight and persistence of constipa- 
tion. Low percentage of sugar also retards the gain in weight, while 
its employment in excessive quantities induces nictations, regurgita- 
tion of food and causes loose, greenish stools. If there are no 
symptoms of disturbance of digestion and the weight remains station- 
ary, or there is but slight gain, the quantity and proportion of the 
ingredients should be increased. 

There is no occasion for the employment of patented foods, for 
they are, as a rule, very deficient in fat, and seemingly good results 
are dependent on the amount of milk used in their home modification. 
Condensed milk, used too largely by the poor, is objectionable on 
account of the large amount of cane sugar used in its preparation, 
and when diluted sufficiently to reduce the casein to 1.5 per cent, the 
fat is lowered to 144 per cent., while the total amount of sugar (milk 
and cane) is 8.73 per cent. It is true some infants seem to thrive 
and grow fat on its use, but the greater number become rachitic or 
suffer from some form of gastric or intestinal derangement. If a 
dilutent other than water be employed, I have found that barley water 
is the least objectionable and often of service, especially where there 
is a tendency to diarrhoea, while oatmeal water is of use to overcome 
the persistence of constipation. They should be used in the place of 
the usual amount of water employed and not added to the mixture 
in general, as the resulting dilution would be too marked. 



HUNTERDON COUNTY. . 

To the Chairman of the Standing Committee^ &c.: 

The two regular meetings of this district medical 
society were well attended and the usual interest mani- 
fested in the proceedings, but nothing of sufficient 



REPORTS OF DISTRICT SOCIETIES. 425 

importance was presented to be made a matter of record. 
Blanks requesting information were, forwarded to all of 
our members, of whom three kindly responded. The 
burden of these responses was " nothing of interest 
to report." 

The past year has been noteworthy for the absence of 
serious epidemics or endemics. Dr. E. D. Leidy, of 
Flemington, reports the occurrence of a few cases of 
measles during the winter and the prevalence of influenza 
('* la grippe ") during the winter and early spring. 

Dr. P. McGilly of Lambertville, reports a few cases of 
diphtheria. Sporadic cases of scarlet fevet, usually mild 
in character, have appeared at Stockton and Lambertville, 
and probably in other localities. 

With reference to " milk as a culture medium and its 
capacity to spread infectious diseases," Dr. O. H. Sproul, 
of Flemington, says : ** I have no facts to give, either to 
its being a medium or its capacity to spread disease. I 
should judge that milk could be infected easily by 
typhoid and diphtheritic germs and thus produce epi- 
demics, and it might be that other infections could be 
propagated and conveyed through this medium." 

Dr. P. McGill says : " I consider milk as a most excel- 
lent culture medium for pathogenic bacteria and have no 
doubt of its being the means of conveying disease to a 
large number of individuals." 

It is a pleasure to be able to report that no deaths 
have occurred in our ranks during the past year. 

G. N. BEST, Reporter. 
ROSEMONT, N. J., May i, 1898. 



426 MEDICAL SOCIETY OF NEW JERSEY. 

MERCER COUNTY. 

To the Chairman of the Standing Committee ^ &c.: 

Through the kindness of Dr. McGalliard, the health 
officer of the city of Trenton, I can report the following 
contagious diseases for the year ending May 31, 1898: 
Diphtheria, 126 cases; mortality, 18; per cent., 16.17. 
Scarlet fever, 126 cases; mortality, 4; per cent., 3.6. 
Typhoid fever, 117 cases; mortality, 12; per cent., 10.3. 
Measles prevailed largely, with quite a number of deaths 
from broncho-pneumonia. There was considerable epi- 
demic of parotidis and pertussis. 

The papers read before the society during the year 
were instructive and interesting, and were as follows : 
" Report of 165 cases of Measles," by Dr. C. F. Adams. 
In abstract the paper is as follows : The disease was first 
noted by Rhazes and the Arabian physicians, and was 
confounded as a variety of small-pox, and even as late as 
1670-74, in London, with scarlet fever. Two epidemics 
unexampled in virulence were noted, viz., In 1846, in the 
Faroe Islands, and in 1875, in the Fiji Islands, where 
40,000 out of a population of 150,000 died. The mor- 
tality of London averages one death from measles in 
2,000 population yearly. The mortality is usually due to 
complications. 

After noting two recent epidemics in Trenton, 1887 
and 1895, he gave the tables of ages in his 165 cases, which 
varied from thirty-one cases at five years to one case at 
thirty-five years. 

The complications noted were : 

Broncho-pneumonia, 5 cases, with i death. 

Laryngitis, 3 " i 

Entero-colitis, 6 " 2 

Convulsions, 4 " i 

Mortality of 2.42^. 



u 



REPORTS OF DISTRICT SOCIETIES. 427 

The treatment consisted of rest in bed, liquid diet, 
citrate of potash, and paregoric for the fever and cough, 
bismuth and cinnamon water for enteric complications, 
also starch water and laudanum enemas, bromides and 
chloral for the convulsions. Hot water and saturated 
solution of acid boric for conjunctivitis. Inunctions of 
carbolized vaseline for the itching of the skin. For the 
laryngitis, inhalations of comp. tr. benzoin, Dover's 
powder and calomel internally. For the broncho-pneu- 
monia, cotton jacket, liq. ammon., acetat and morphine 
for cough. The consensus of opinion at the end of the 
discussion was put in a motion by Dr. Adams as follows : 
Whereas, we have no means of preventing measles 
either in the adult or child, except that produced by 
the disease itself, therefore we believe it is not wise to 
isolate measles. 

Dr. B. W. McGalliard presented a paper entitled, ** A 
Question of Therapeutics." The special points in it 
were as follows : Why is it that a drug that seems to 
act promptly and surely at one time, should utterly fail 
at another when used in the same person for seemingly 
the same condition ? We seem to get results sometimes, 
and as certainly fail to obtain them at another. What 
is the explanation of this uncertainty of action ? Is the 
discrepancy in the patient, in the physician, or where ? 
Is not the reason of the failure of medicine to cure dis- 
eased condition to be found in the fact that the cause of 
the disease was an unbalanced nervous control and the 
medicines do not affect the cause? If we acknowledge 
that the mental condition may be the cause of a diseased 
physical condition, then the practical conclusion reached 
is, that there are other more powerful methods and forms 
of treatment than drugs. Parocelsus says : *' The philo- 
sophic physician needs to employ strong will, benevo- 



428 MEDICAL SOCIETY OF NEW JERSEY. 

lence, charity and patience." Da Costa says : ** In the 
next decade, too, we may look for some striking develop- 
ments of suggestion, not only as explaining mental and 
morbid processes, but also as a harnessed therapeutic 
force." Schofield {Landon Lancet) says : ** The subcon- 
scious region of the mind can affect, through its wonderful 
powers, the nutrition and health of the body to an illimit- 
able extent, and, indeed, is the only real agent in most 
cases." If the mind does play such an important part in 
the causation as well as the cure of the diseased condi- 
tions, then it becomes us to ponder upon mental thera- 
peutics, its principles and practice. 

Dr. J. W. Ward, N. J. State Hospital, Trenton, pre- 
sented a paper on '' Delusions as a means of Diagnosis of 
the Insane Condition." The Doctor defined the terms 
and condition of the mind in delusions, hallucinations, 
paresis and illusions, and cited cases to illustrate each. 
Dr. H. B. Cost ill presented a paper on " Uterine Displace- 
ments, their Diagnosis, Treatment, etc." Dr. A. I. Hunt 
presented a paper on " Intestinal Antisepsis." He com- 
mended the use of bismuth subgallate in dyspepsia^ 
typhoid fever and various inflammatory diseases of the 
alimentary canal. Dr. Costill spoke highly of the climate 
of Nova Scotia, being an ideal one for hay fever and 
many other diseases. The temperature varied during a 
two weeks stay from 54® to 68^ F. After four days stay 
all symptoms of hay fever entirely disappeared. He also 
spoke of a case of indigestion and diarrhoea, immediately 
improved without medicine. 

Dr. Cantwell reported a case of head injury from falling 
into a sand pit, a distance of about four feet. After 
recovering consciousness, he had incoherence of thought 
and half vision. On examination, typical ''cracked pat" 
sound on percussion over right frontal area was found. 



REPORTS OF DISTRICT SOCIETIES. 429 

On raising a horse-shoe flap in that area a fracture five 
inches in extent was found. After trephining, the dura 
was found intact, but a number of fragments of bone 
were found pressing on the brain and were removed. 
Incision of dura gave vent to i^ oz. of clear serum. The 
man recovered nicely with the exception of slight incohe- 
rence/and could only see about ten feet, at time of report. 

Dr. Hawke reported a case of masturbation in a male 
child eighteen months old, which was followed,, after a 
time, by complete loss of power in both lower extremities. 
Decided improvement followed the use of bromides and 
restraint. In discussing the same. Dr. J.C. Felty recom- 
mended the use of muff and detailed a successful case 
so treated at the N. J. State Hospital. 

Dr. Schoening reported two cases of inguino-properi- 
toneal hernia cured by operation. Dr. Van Horn re- 
ported a number of rare cases in the practice of a country 
doctor : One acute loba, pneumonia with haemorrhagic 
.diathesis; two second infections of scarlet fever; two 
fractures of the sternum. During the year there has been 
conlsiderable discussion regarding hospital abuse and the 
following theme was discussed by a committee represent- 
ing both the St. Francis and Mercer hospitals, of which 
Dr. H. G. Norton was the chairman, viz., plans for miti- 
gating the abuse of medical charity, who gave the follow- 
ing report : " We wish to express the conviction that there 
is no species of charity so beneficent, so far-reaching or 
so generously bestowed as true medical charity, and that 
nothing could be further removed from our wishes than 
that it should be curtailed or kept from the reach of the 
deserving poor, but it has been so conclusively demon- 
strated that there exists such gross and unpardonable 
share of that charity on the part of those who are not 
entitled to it, that it is imperative to adopt radical 
means for its suppression." 



430 MEDICAL SOCIETY OF NEW JERSEY. 

*• We recommend that those persons seeking treatment 
at our dispensaries, shall bring a note, either from some 
physician, charitable organization or minister, stating 
that the bearer (giving name on note) is poor and unable 
to pay for medical attendance. At the hospital or dis- 
pensary, signs shall be posted stating free medical service 
is for the poor only, and a card shall be given each applicant, 

stating on the back that Mr. or Mrs. is too poor to pay 

for medical service and so is entitled to dispensary 
attention. Each dispensary shall keep a record of all 
applicants, of their names and addresses, which shall be 
bi-monthly submitted to a central charitable organization 
to determine the truthfulness of the patients' assertion. 
These rules shall not prohibit a dispensary physician 
from seeing an emergency case once. Patients occupy- 
ing and paying for private rooms in hospitals shall not 
be entitled to free services of tlie visiting staflF." 

Dr. Chas. R. Burroughs, President of the society, died of 

apoplexy November lo, 1897, of whom a full obituary 

notice will be found. 

GEO. N. J. SOMMER, Reporter. 



Report of the Proceedings of the District 

Medical Society of the County of Mercer, 

AT their Fiftieth Anniversary. 

BY G. N. J. SOMMER, SECRETARY. 

The society met in the Colonial Room of the Trenton House and 
was called to order at 8 p. m. by the President, Dr. John Bruyere. 
This was followed by the calling of the roll by the Secretary, Dr. 
Geo. N. J. Sommer. The society was well represented, over four- 
fifths of the members being present. Prayer by the Rev. S. M. Studdi- 
ford followed. The President then introduced Dr. Cornelius Shep- 
pard, one of the two oldest members of the society, (Dr. R. R. Rogers, 
Sr., being the oldest), who read a carefully prepared address on " The 
History of the District Medical Society of Mercer County, with short 



REPORTS OF DISTRICT SOCIETIES. 43 1 

sketches of its founders," as well as of many of the other gentlemen 
who have been members of the society during the time he has t)een^ 
associated with it. His essay follows. 

Following the reading of Dr. Sheppard's paper, the society had the 
pleasure of hearing an elaborate paper by the President, Dr. John- 
Bruyere, on " The Progress of Medicine during the past Fifty Years." 

The society and its invited guests, amongst whom were the follow- 
ing: His Honor the Mayor, Welling G. Sickel, President of the 
Council. Frank S. Katzenbach, Col. Thomas S. Chambers* Prof. J. M. 
Green, of the State schools. Dr. D. C. English, President of the State- 
Medical Society, corresponding members from the Burlington County^ 
Society, Dr. I. D. Young, of Bordentown, Profs. H. C. Wood and 
Hobart A. Hare, of the University of Pennsylvania and the Jefferson 
Medical College respectively; the following clergymen representing 
various denominations in this city — Rev. Judson Conklin, Baptist; 
Rev. £. B. Kellinger, Lutheran ; Rabbi L. Weiss, Hebrew ; S. M. 
Studdiford, Presbyterian ; W. Strather Jones, Episcopal ; and the fol- 
lowing newspaper men — Francis B. Lee, editor of the Times and 
Free State Gazette ; H. McAlpin Phillips, of the True American^ 
adjourned to the grill room and partook of the following menu. Dr. 
William Elmer acting as toastmaster. The banqueting hall was 
suitably decorated, the centre piece being a human skeleton bearing 
the nation's colors, which intertwined between his bones. The mena 
card was a peculiarly appropriate one. The outside cover was blood 
red cardboard surmounted by a ghastly white skull and cross-bones, 
above which were the figures 1848, and below, 1898. The menu was. 

36 follows: 

Little Neck Clams, Sterilized 

Consomme Aseptic 

Salted Almonds Olives Radishes 

Cucumbers Potato sara 

Sweetbreads Larded, a la Serum Therapy 

Fresh Asparagus, Hollandaise 

Esculapian Punch 

Boiled Squab on Toast, au Cresson 

Bermuda Potatoes 

Tomato Mayonnaise 

Fancy forms of Ice Cream 

Strawberries Assorted Cakes 

Coffee Cigars 



432 MEDICAL SOCIETY OF NEW JERSEY. 

After partaking of the above, Dr. William Elmer, with many pithy 
and apt remarks, introduced the following gentlemen, who responded 
to the toasts with suitable remarks : 

Dr. David Warman : " Our Society and Her Fiftieth Anniversary." 
He spoke of the men who were associated with the society in the 
days gone by and then read a paper on " Professional Ethics." 

Dr. D. C. English, President of the State Medical Society, responded 
to the following : *' The Medical Society of the State of New Jersey," 
and stated that the society had furnished five Presidents to the State 
body— John Woolverton, J. W. Ward, J. B. Coleman, William Elmer 
and T. J. Corson. 

" The City of Trenton " was responded to in fitting words by the 
Mayor, Welling G. Sickel. 

" The City Council, whose Chambers is our Society's Home," by the 
President of that body, F. S. Katzenbach, Jr. 

" The Board of Health, Our Adjunct Body." Mr. G. D. W. Vroom, 
President, was to have been responded, but sending a letter of regret. 
Col. Thos. Chambers, a member of the board, and Dr. B. W. McGaU 
liard. City Health Officer, replied. 

" The Relation of the Medical Profession to the Education of the 
Laity," was given to President Carroll Robbin, of the Commissioners 
of Education, but owing to his absence, for which he sent his regrets, 
the toast was suitably responded by Prof. J. M. Green, Superintendent 
of the State Schools. 

" Our Relations as Citizens and Promoters of Municipal Improve- 
ments," was allotted to President Ira Wood, of the Board of Trade, 
who sent his regrets, being detained out of the city on business. 

" The Salutary Influence of the Press in matters of Hygiene and 
Sanitation," was responded to by Francis B. Lee, editor of the 
Trenton Times, 

"To our Corresponding District Medical Societies." was fittingly 
responded to by Dr. I. D. Young, of Bordentown. Dr. W. H. Shipps, 
of the same place, sent a letter of regret, as also did Dr. W. H. G. 
Osborne, of Morrisville. Pa., the corresponding member for Bucks. 

" To our Brethren in the Profession from other States," was fit- 
tingly responded to by Profs. H. C. Wood and H. A. Hare. Letters 
of regret were received from Drs. T. S. K. Morton and Judson 
Daland, both of Philadelphia. 

"To our Staunch Friends in the Clergy of all Denominations,' 



REPORTS OF DISTRICT SOCIETIES. 433 

was responded to by the following gentlemen for their denominations : 
Baptist— Rev. Judson Conklin. Episcopal— Rev. W. Strather Jones ; 
the Bishop Scarborough, owing to injury, being unable to be present, 
sending his regrets. Hebrew — Rabbi L. Weiss. Lutheran — Rev. E. B. 
Kellinger. Methodist— The Presiding Elder, Wesley Lake, was unable 
to be present. Presbyterian — Rev. S. M. Studdeford. Roman 
Catholic— The Rt. Rev. Bishop James A. McFaul sent regrets. 

The meeting adjourned about 2:30 a. m., all present feeling that they 
had spent a very enjoyable evening. Much thanks are due the Com* 
mittee of Arrangements for the very successful manner in which 
everything was carried out and for the very enjoyable evening they 
gave the members. The committee consisted of John Bruyere^ 
President ; William Elmer, Treasurer, and Cornelius Sheppard. 



History of the District Medical Society of 

THE County of Mercer, with Short 

Sketches of Some of its Past 

Members. 

BY CORNELIUS SHEPPERD, M.D. 

The cycle of time in its rapid revolution has brought us to the half- 
century period in the history of our society, and we have assembled 
this evening to celebrate the fiftieth anniversary. On this Golden 
Anniversary occasion our feelings of joy and gladness are tinged 
with sorrow and sadness that not one of those who organized the 
society is present to receive our congratulations. All have passed 
away ; gone before the just and righteous Judge of all to render an 
account of their work done while here. 

At the May meeting of the New Jersey State Medical Society, in 
1848, Drs. John H. Phillips, Henry P. Willing, James B. Coleman, John 
McKelway and Francis A. Ewing made application requesting a 
commission for the institution for a district medical society for the 
county of Mercer. This application was considered and the request 
granted. On May 23, 1848, these tive men met at the house of Samuel 
Ray, Trenton, New Jersey, and organized by the appointment of Dn 
John McKelway, President and Dr. John H. Phillips, Secretary, after 
which Dr. George R. Robbins and Dr. John L. Taylor were proposed 
and elected members of the society. A code of by-laws and rules of 



434 MEDICAL SOCIETY OF NEW JERSEY. 

order were presented and adopted. Dr. James B. Coleman was 
appointed essayist for the next meeting, and John McKelway» James 
B. Coleman, Henry P. Willing and George R. Robbins were 
-appointed delegates to the State Medical Society. Such was the 
•beginning of the district medical society for the county of Mercer. 
The gentlemen who constituted the germ of this society were men of 
marked ability. 

Dr. John McKelway was bom in Glasgow, Scotland, in 1778. He 
graduated in medicine in the University of Edinboro, and in 18 19 
came, with his wife, who died in 1866, to the United States. He first 
settled in Lancaster, Pa., where he remained about one year, when he 
•came to Trenton, where he practiced medicine for over fifty years, 
being recognized as one of the leading physicians and surgeons in the 
city, of his day, and numbering among his intimate friends in the pro- 
fession, the great men in it in America, Including the first McClellan, 
the elder Gross, Joseph Pancoast. and others of like celebrity. He 
-amassed, what was for his day, a fortune, being interested in many 
business enterprises and also being a wise and shrewd investor in 
real estate in Trenton. In character he was a rare man, being, while 
always courteous and polished in the extreme in manner, of iron will 
and determination, ignoring difficulty, danger or fatigue in whatever 
he undertook to accomplish. He was a member of the Third Presby- 
terian Church but left it to help form the Fourth Church. In his last 
years he attended, because of its nearness to his residence and his 
life-long respect and friendship for John Hall, D.D., its pastor, the 
First Presbyterian Church, 

The iron quality of Dr. McKelway's character is shown by the fact 
that having, in 1861, in his seventy-third year, suffered an inter- 
capsular fracture of the thigh bone, and having lain in bed a few- 
weeks with it in splints, until he and his physician became convinced 
that union was impossible, he got up on crutches and practiced 
medicine on them and his useless limb thereafter for ten years. He 
had. during the time, a special carriage made, into and out of which 
he could get with his crutches, and to the great anxiety of his family 
and friends, used as he always had, the fastest and most spirited 
horses obtainable, and permitted no one to handle the reins but 
himself. He died in 1877, having been confined to the house for 
about six years. Of his children who survived infancy the eldest was 
Dr. Alexander T. McKelway, who died in 1885, the father of the late 



REPORTS OF DISTRICT SOCIETIES. 435 

Hev. John R. McKelway and St. Clair McKelway, LL.D., editor of 
the Brooklyn Eagle, and Dr. George I. McKelway, of Philadelphia. 
He had other sons, John and George, who did not marry, and who 
died some years ago. His daughters were, Margaret, who married 
the late Dr. W. W. L. Phillips, and died in i860, and Louisa, a lady 
tenderly remembered by Trentonians. who died unmarried in 1862. 

Dr. McKelway was the last of his name, and had he died childless 

•the name would have perished with him. As it is, St. Clair McKelway, 

LL.D., and Dr. George I. McKelway are the only men of their name 

\n the world. A son of Dr. George I. McKelway, Dr. John I. 

McKelway, is a resident physician in the Philadelphia Hospital, and is 

-of the fourth generation of an unbroken line of physicians— earnest, 

faithful practitioners of medicine who left their impress upon the 

history of the profession and who in any age, business or profession, 

'would make a success. During the early period of the society they 

had their own censors. In 1848 Drs. McKelway, Coleman, Phillips 

and Robbins were appointed censors for the District Medical Society 

for Mercer. It was the duty of these censors to examine candidates 

for the practice of medicine and to grant certificates which entitled 

the holder to a diploma from the State Medical Society. In 1849 the 

censors of this society examined and granted certificates to two 

-candidates. These are the only ones on record, although the society 

had its censors until January, 1866. The law had become obsolete, for 

the writer commenced the practice of medicine in Trenton on July 

22, 1 861, on the authority of his diploma from the University of 

Pennsylvania. 

The history of medical legislation prior and subsequent to the act 
•of 1 816, authorizing the State Medical Society to appoint censors, is 
interesting. Prior to 1772, medical practice in New Jersey was 
subject to no laws, and membership to the State Society was by 
examination. In 1772 the Colonial Legislature, being solicited by the 
State Society, passed an act " to regulate the practice of physic and 
surgery in the colony of New Jersey." This act " vested the licensing 
.power in at least two Justices of the Supreme Court, who were 
required to examine candidates with the aid of two such physicians 
.and surgeons as they might select," and it was not until 18 16 that an 
act was passed vesting this power in censors appointed by the State 
Society. By an act, March, 1851, the President of the State Society 
<was authorized and required to grant a license to the graduates of 



436 MEDICAL SOCIETY OF NEW JERSEY. 

five colleges — the College of Physicians and Surgeons, New York; 
the medical depart nf)ent of the University of the City of New York ; 
the medical department of the University of Pennsylvania ; Jefferson 
Medical College, and the medical department of Pennsylvania College,, 
of Philadelphia. In 1854 a supplement to this act was passed, throw* 
ing open the door to graduates of all colleges requiring a certain 
curriculum of study. This practically did away with the usefulness 
of the censors who, between 18 16 and 1842, had licensed 366 appli- 
cants. This society protested against the act of 1854, and at their 
January meeting in 1855, they discussed the propriety of petitioning 
the legislature to repeal the statutes of 1851 and 1854, and return- 
ing to the statute of 18 16, which required medical censors. They 
also passed a resolution "that in the opinion of this society the 
only true test of the qualifications of a practitioner of medicine 
is through personal examination by a well-qualified board of 
medical examiners." At this time the society recognized the necessity 
for the separation of the department of teaching from the licensing 
power, but later the society reversed this opinion. In March, 1889, 
the society received a communication from the State Society request- 
ing its views *' in regard to the advisability of establishing a State 
Board of Medical Examiners." This society did not endorse this 
idea, " believing that the best interest of the public and the profession 
would be secured by the enforcement of existing laws. 

The society has had no. permanent abiding place for holding its 
meetings, though it has made many attempts at different times to 
secure one, but without success. It held its meetings at Samuel 
Ray's hotel where it was organized, until April 1851, when it moved to 
the house of Samuel English, where it remained for one year. In 
April, 1852, it moved to Temperance Hall. In October, 1863, the 
society moved to the office of Dr. Corson, corner State and Mon- 
gomery Streets, where it held its meetings until May, 1866, when it 
moved to the Young Men's Christian Association rooms, 63 Warren 
Street. It did not long tarry here, for in July, 1866, it moved to the 
City Hall, remained here until May, 1882, when it moved to the Board 
of Trade rooms. In March, 1883, it moved to the Board of Health 
room, remained here until March, 1885, when it moved to the Council 
Chamber, where it has since remained and now holds its meetings. 
All of the meetings of the society were held in Trenton, except two. 
On June 2, i860, the society met at Dr. Bartines, at Princeton, and 



REPORTS OF DISTRICT SOCIETIES. 437 

there partook of an elegant dinner which had been prepared by the 
members residing in Princeton. In July, 1870, they again revisited 
Princeton. From 1858 to 1892 meetings were held on the first 
Tuesday in every month. Prior to this there was no definite date or 
time for meeting. Meetings were usually called during the fore part of 
the month, were held in the afternoon, and arranged for by the 
President or Secretary of the society. At the July meeting, 1 892, the 
date of the stated meetings was changed to the second Tuesday in 
every month, except July, August and September, and the time was 
changed from 2.30 p. m. to 8.00 p. m. Until 1873, the annual meet- 
ings and election of officers were held in January. After this they 
were held in May. 

The District Medical Society of Mercer County has always ^aken a 
prominent and active part in local affairs, especially those pretaining 
to hygiene or sanitation. It early and presistently urged upon 
Common Council the necessity of a pure water supply, of abating 
nuisances and of passing an ordinance regulating the spread of con- 
tagious diseases. It also urged the necessity of establishing a dispen- 
sary, a hospital and sewers. In 1855 it recommended to the City 
Council the establishment of a city hospital and dispensary, and in 
1864, '67 and '70, committees were appointed favoring a dispensary, 
believing that ** such would be a credit to our city and a highly useful 
charity." In 1870 the necessity for a hospital in Trenton was fully 
recognized and the society tendered their earnest and cordial support 
to the German Catholics who were striving to erect a hospital in 
Trenton, and when completed, prominent members of this society 
were selected to organize the medical and surgical staff, and from the 
opening of the institution, up to the present time, the staff, without 
exception, have been members of this society. 

In 1 87 1 there was an epidemic of small-pox in Trenton, and the 
society adopted a resolution requesting Common Council to take such 
action as would make it obligatory upon the physicians of the city to 
report to the Board of Health every case of contagious disease occur- 
ring in their practice as soon as the character of the case was known* 
This was a wise precaution and has been in force ever since. In 
1873 the society favored sewers as the best means of removing drainage 
from cities, and in 1877 the *' pollution of our waters*' was discussed, 
and it was urged upon council " that to sewer into rivers was in- 
jurious to the health of the community, as water containing decom- 

S8 



438 MEDICAL SOCIETY OF NEW JERSEY. 

posing animal and vegetable matter was a very common cause of 
disease and served as a medium for conveying germs of certain 
diseases from one person to another," and it was also urged that " the 
collection in cesspools was of the greatest value, and if properly 
utilized, could be made one of the best fertilizers instead of being 
thrown into our waters, to the detriment of the public and the fish 
interest. In 1885 the society commended the proposed sewer system 
as conducive to the best physical and financial interest of the city, 
and in 1897 appointed a committee to advocate before council the 
necessity of filtering our water supply. 

In 1882 the society advocated the necessity of providing a hospital 
for the reception of contagious and infectious diseases, and in June, 
1895, resolutions were passed favoring the establishment of a bacterio- 
logical laboratory in Trenton. Not only in the above, but in many 
other ways the society has attempted to conserve the best interests 
of the city and has been fully abreast of the times. The work of the 
society for the advancement of medical science and efficiency in 
practice has been large and worthy very great commendation. In 
1867 an effort was made to establish a medical museum and library, 
and had it been adopted, as it should have been, the society would 
today have a home for its meetings and a library and museum of no 
mean proportions. 

From the very organization of the society a spirit of earnestness 
has characterized all their work. Essayists were appointed for each 
meeting and each member was required to discuss the essays read or 
to investigate some subject and report upon the same in writing. In 
1867 the society decided that "any member shall be fined for the 
unjustifiable neglect of any duty he has consented to perform." In 
June, 1889, a committee was appointed to procure essays, to provide 
matters of interest and to arrange for better medical discussions, but 
in May, 1891, this duty was vested in the President. The essays, 
discussions and reported cases that have come before this society have 
been numerous and important, and show conclusively that many of 
the members of this society were men of enquiring minds, versatile 
and accomplished, as will be shown later in brief sketches of their 
lives. In their essays and discussions we find less of the scientific 
spirit than at present, but we find a poetic temperament that gives to 
ail their productions a kaleidoscopic and irridescent effect. We find 
in their essays, mythology, theology, philosophy, chemistry, poetry. 



REPORTS OF DISTRICT SOCIETIES. 439 

science, physic, song and story all mingled together in one grand 
effusion. There are many mythological and biblical references and 
poetic effusions. 

We could not better illustrate the breadth and versatility of our 
predecessors than by giving the subjects of some of their essays 
between 1848 and 1870, which are varied, scientific and ponderous. 
They are as follows, viz.: " Vis Medicatrix Naturae," *' Similarity of 
Galvanic and Nervous Fluids," "Germination of Wheat in an Ice 
House," " Present Style of Female Dress," " Effects of Atmospheric 
Changes upon Animal Functions," "Mechanical Construction of 
Animals," *' Model Machines." " Animal and Mechanical Dynamics," 
*' Imponderable Forces and their Action upon Organic and Inorganic 
Matter," "The Influence of Sunlight upon the Vital Powers." " The 
Co-relation of Forces," "Croup Poisoning and its Effects." "The 
Relation of External Objects to the Mind," "The Laws of Vital 
Development and Decay," " Science and Ecclesiasticism," " Will the 
Coming Man Drink Wine?" This essay was written in 1868. 

Dr. Charles L. Bonsel. elected in October, 1855, was expelled Octo- 
ber 12, 1858, for violation of the Code of Ethics of the Medical 
Society. In 1882 complaint was made to the society that the Code of 
Ethics was being violated, and in February, 1882, a resolution was 
passed instructing a committee to investigate the matter and "to 
make diligent inquiry as to the moral excellence of each member, also 
as to whether they are temperate in all things." No report was made, 
but peace and harmony has since prevailed. 

From the beginning of the society delegates have been elected to 
national. State and county organizations. They have been elected to 
the National Medical Association, to the American Medical Association 
annually to the State Society and to the county societies. The society 
has received delegates from Hunterdon, Burlington and Bucks Coun- 
ties and has sent delegates to Hunterdon and Burlington. Per- 
manent delegates to the State Society were 6rst elected in 1891. In 
1883 the society attempted a literary venture. The Mercer County 
Medical Review was instituted but it was nipped, unfortunately, by 
an early frost. A committee on membership was first appointed in 
1885. The publication of notices for monthly meetings was first 
authorized in February, 1896. The society assisted in the formal 
opening of the Trenton Pathological Association, in April, 1895. 
The by-laws adopted May 23, 1848, were revised and amended 
January 19, 1858, April I, 1873. and October 6, 1885. 



440 MEDICAL SOCIETY OF NEW JERSEY. 

In January, 1855, a resolution was unanimously adopted that to 
Section 3 of the by-laws shall be added, " and it shall be the duty of 
the President, on retiring from office, to address the society." The 
retiring President^ addressed the society in 1 856, but as this resolution 
was never incorporated in the by-laws the address by the retiring 
President has remained optional. In July, 1892, resolutions changing 
the date of the stated meetings from the first to the second Tuesday 
in every month except July, August and September, and changing the 
time of meeting from 2.30 p. m. to 8 o'clock, p. m. remains yet to be 
incorporated in the by-laws, as does also the annual dinner. In June, 
1893, in order to favor sociability, it was deemed advisable to have 
an annual dinner, and it was ordered that " the President, Secretary 
and Treasurer be appointed a committee to arrange for the time, 
place and manner of holding a dinner, the expense to be borne out of 
the funds of the Society." These dinners have been held annually 
on the regular meeting in November, and addressed by Prof. H. C. 
Wood, H. A. Hare, H. N. Biggs, F. S. R. Morton and Dr. J. Daland. 

The remarkable progress made in medicine during the last half 
century has been well reflected in the proceedings of this society. 
The essays read, the discussions and cases reported, show con- 
clusively that the society has kept pace with the rapid advance of 
medical science. From the inauguration of this society down to the 
present, it has been represented by men of the first rank in the pro- 
fession, and now, without exaggeration, she has today, whether in 
medicine or surgery, those capable, through experience, knowledge 
and skill, of rendering all the relief from pain and disease which the 
present light of science a£fords. As further evidence that this society 
has in all these years kept abreast of the times, is that it has furnished 
five presidents for the State Medical Society in the following order, 
viz.: James B. Coleman, in 1855 ; John Wolverton, in 1862 ; Thomas J. 
Corson, in 1868 ; John W. Ward, in 1887, and William Elmer, in 1895. 

I have here statistics for the fifty years, giving each year the name 
of the president, the number of members, the number of meetings, 
the number of essays read, the number of cases reported, the names 
of members elected, the names of those who died, resigned, removed 
from the county or dropped from the roll. We have had 148 mem- 
bers ; forty-two have died, fifty resigned, moved from the county or 
been dropped from the roll, and one was expelled. We have now 
fifty-five members, all ^in (good standing. 



REPORTS OF DISTRICT SOCIETIES. 44 1 

This is a brief outline of the transactions of the society during its 
existence, very inadequately presented, from very imperfectly kept 
minutes. The real or true history of the society is the life, work and 
character of its members. The living are still making history and we 
will pass them over for the pen of the historian of the centennial 
anniversary, by which time most of us present will have finished 
our work and passed on to the next world to receive our reward. 
May we receive God's choicest blessing — a crown of righteousness — 
is my sincere wish and earnest prayer. 

I will now give a brief sketch of the work and character of some of 
the members who were propiinent in the society and the community, 
and though dead, their good deeds and noble traits of character will 
ever be lovingly cherished and gratefully remembered. These kind 
words have been compiled from the memorial page and from every 
available source of information. It is the evidence of friends who 
knew their worth and gave them credit for these noble traits of head 
and heart. It was my exceeding great pleasure to enjoy the acquaint- 
ance of a majority of the men who organized this society, as well as 
most of those who have since composed its membership, and it affords 
me pleasure, which words are utterly inadequate to express, to bear 
testimony to their noble deeds of kindness, the cordial welcome, the 
cheering encouragement, the professional courtesy and help, the 
fatherly advice they gave me, who came here an entire stranger on 
that memorable historic occasion, July 22, 1861, to engaged in the 
practice of medicine. 

Dr. Francis Armstrong Ewing, a son of the late distinguished Chief 
Justice of New Jersey and a grandson of the Rev. James F. Arm- 
strong, was born in Trenton, September, 1806. and died Decem- 
ber ID, 1857. He received his preparatory education at the Trenton 
Academy, after which he entered Princeton College, and graduated in 
1824; read medicine with Dr. Belleville and took his degree in medi- 
cine at the University of Pennsylvania, after the usual course. In 
1 83 1 he made the profession of his faith in the church of his ancestors, 
and in 1840 was ordained in the eldership. Dr. Ewing well improved 
the advantages of his education and of his natural talents in the 
constant pursuit of knowledge. In the learning of his profession and 
its cognate sciences, in the full course of classical study, in every 
requisite that constitutes accomplished scholarship, he built steadily 
through life upon the foundation of his early training. He was never 



442 MEDICAL SOCIETY OF NEW JERSEY. 

patient, in himself or others, with superficial, indiscriminate learning. 
Slow, regular, exact, fastidious, he was more careful to understand 
thoroughly what he acquired than disposed to hurry over much 
ground. This habit gave him superior qualifications as a teacher, in 
which capacity he is gratefully remembered by many who had the 
advantage of his instruction. How it qualified him for authorship 
may be seen in the ** Bible Natural History," a volume of four 
hundred pages, written by him for the American Sunday School 
Union, of which the " Biblical Repertory " said, in the year of its 
publication (1835), •* We regard it for our own reference as being at 
once lexicon and concordance, and for these ends scarcely inferior to 
the best books on the subject." 

Dr. Ewing possessed a delicate taste in music. He was a performer 
and composer, and his views on the subject of church music are 
given in an article under that title in the " Biblical Repertory " of 
1843. Trained from his childhood in the knowledge of the bible and 
coming into the church in his early manhood, he continued to pursue 
the study of divine truth, so that he was not merely an intelligent 
believer, but might properly be characterized as a well-grounded theo- 
logian. In religious and ecclesiastical, as well as in political, educa- 
tional and every other department of human concerns, Dr. Ewing was 
always on the side of conservative stability. He was sure to be 
found on the well-timed platform of experience, in preference to that 
of the most plausible novelties of theory or expediency. Too sensi- 
tive, too unambitious, constitutionally reserved, deficient in worldly 
energy, the effect of these peculiarities was to conceal some of his best 
and noblest qualities from general observation. Because he was 
averse to demonstrations, many thought him cold and exclusive; 
but there are not a few who understand his true character 
and who know and feel that never was there a warmer, more delicate, 
invariable and enduring friendship than his, to such as he believed at 
all responded to that sentiment. 

His sense of honor, integrity, and fidelity in all things was not too 
high or scrupulous as compared with the standard of the bible, but it 
may be said to have been too high in its expectations for the infirma- 
ties of human nature. The qualities of Dr. Ewing's piety may be 
inferred from what has been said of his general character. Well- 
grounded, experimental, unobtrusive, tender, it was when sympathy 
called it forth toward the afflicted believer, or the awakened conscience. 



REPORTS OF DISTRICT SOCIETIES. 413 

or in acts of devotion that it was brought into notice and appreciation, 
rather than in the n)ore ordinary incidents of life, where it is easier for 
insincere character to seem than to be. Only a few hours of illness 
admonished him that he was about to die, but the summons gave him 
no alarm. He indicated, with professional sagacity, the fatal symp- 
toms, and calmly spoke and prayed until his spirit was gently released. 

John H. Phillips, M.D., was bom in Hopewell Township, this 
county, in 1814, and on his mother's side was a lineal descendant of 
Gov. Reading, one of the colonial governors of this State. He com- 
menced the study of medicine under Dr. Springer, of Pennington, N. J,, 
as his preceptor, but before he finished his course Dr. Springer died 
and he finished his studies under Dr. H. P. Willing's supervision. He 
graduated in 1838, and immediately commenced the practice of medi- 
cine at Taylorsville, Pa. Subsequently he moved to Pennington, where 
he spent twenty-three years of the prime of his life in a laborious 
country practice, discharging his duties with great faithfulness and 
success. As a physician he was far above mediocrity. Understand- 
ing well the theory of his profession, careful and gentle in his practice, 
with a heart full of sympathy for human suffering, he was trusted and 
greatly beloved by his patients. At the breaking out of the War of 
the Rebellion he was appointed surgeon by President Lincoln and 
assigned to the army of the Cumberland. His first appointment was 
at Nashville, Tenn., in charge of hospital No. 14. 

After some nine months or more of service there, he was ordered 
to the front and became medical director of the Fourteenth Army 
Corps, commanded by Gen. Jefferson C. Davis. He did valuable 
service on the march to Atlanta, especially at the battle of Kenesow 
Mountain, where he and his assistants relieved and dressed the 
wounds of goverment officers and men before midnight of the day of 
the battle. After Gen. Sherman started on his famous march to the 
sea. Dr. Phillips was placed in charge of the post hospital at 
Chattanooga, where he remained until the close of the war, and for 
his valuable services was brevetted Lieutenant-Colonel of Volunteers, 
U. S. A. He was an active member of the medical society of this 
county, and in 185 1 was President of the State Medical Society. 

Apart from his medical work, Dr. Phillips has a good record as a 
citizen of New Jersey. For nine years he held the responsible posi- 
tion of State Superintendent of Public Schools and did much in his 
official capacity to increase the efficiency of our common schools. It 



444 MEDICAL SOCIETY OF NEW JERSEY. 

• 

was during his incumbancy of that office that the State Normal 
School was founded, and in the success of which iustitution he always 
felt a warm interest. Twice chosen to represent his district in the 
State Legislature, he was chosen Speaker during his second term, and 
performed the embarrassing duties of that position with such fidelity 
and impartiality, as to give satisfaction to all parties. In politics a 
Democrat, but not radical, sustaining his party only when right, 
believing that true Democracy was true government. 

For fifteen years he was Grand Secretary of the Grand Lodge of 
Odd Fellows, and at the time of his death was treasurer of the city of 
Beverly, and one of the trustees of the Farnum Preparatory School. 

The following, from a letter to his wife after his death, from a 
friend and brother physician who attended him during his last sickness, 
fully delineates his private and social character : 

" Twenty years ago I became acquainted with your late husband. 
From that time an attachment sprang up between us which grew and 
increased with our years, leading to the full maturity of confidence. 
Dr. Phillips was no ordinary man. To those first meeting him he 
seemed reticent, unapproachable, withdrawing himself from contact, 
seeming to live within himself. This was only his exterior nature ; it 
was the covering of a hidden life of goodness, ripe judgment and 
true heartedness, which developed as you learned to know him, and 
every attribute of his soul manifested itself as he drew nearer to you in 
his confidence. 

" To appreciate your husband was to know him in his social life. 
In our many hours of intimate intercourse, his characteristic traits 
developed, and it formed the most pleasant epoch of my life to listen 
to words of wisdom and advice in the social hours we spent together. 
He seemed to relax himself and speak with freedom, friend to friend. 
Many such hours have we passed together, and though he has passed 
away his spirit lives in hallowed memory. He possessed talents of the 
highest order, and yet so humble, in his own estimation, that scarcely 
would you know his worth, unless called out by some circumstance of 
trial or some emergency, when the full force of his mind would shine 
out in its full brilliancy. But a far higher phrase of his life was his 
meek Christian character. With .no loud pretensions, he moved 
steadily forward, onward and upward in his chosen, blessed pathway. 
Dying, he said ' he would be judged by his life already spent,' and his 
legacy of knowmg how to die he has left us. ' Gently wrapping his 



REPORTS OF DISTRICT SOCIETIES. 445 

-drapery around him he fell asleep.' What greater comfort can you 
have than this? He has gone before and bids you tarry awhile and 
come. Lying in the silent tomb among the quiet sleepers there, 
disturb him not ; the higher jewel, his precious spirit, is with Him, 
who is the resurrection and the life. He will redeem his body and 
watch the cherished dust until the loud sounding of the archangels 
trump shall wake the nations of the sleeping dead. Let us resolve to 
imitate his blessed life by being also ready." 

Henry P. Welling, M.D., was a son of Isaac Welling, a farmer of 
Hopewell. He graduated at Princeton College in 1828 and studied 
medicine with Dr. Springer, of Pennington, and graduated at the 
University of Pennsylvania in 1832. He took the office and practice 
of his preceptor. Dr. Springer, who had recently died. He was a 
successful and honored practitioner, a man of skill and judgment, a 
useful and public spirited citizen, a respected member of the 
Medical Society, State and County. He was one of the original 
members of the society, but was dropped from the roll as a member 
•October 21, 1856. 

James Beakes Coleman was bom in 1806. He was descended from 
ancestors who, long before the Revolution, lived in this city and the 
immediate vicinity. He was educated in Trenton and spent some 
years with an apothecary, during which time he devoted himself 
particularly to chemistry and became, for one of his age and at that 
period, an excellent practical. chemist. He read such books as could 
be procured, sought advice from a Philadelphia friend engaged in the 
same pursuits and was able, under the difficulty that then attended 
•chemical studies, to succeed in making experiments, even making 
sulphate of quinine, a remedy that had within that year been intro- 
-duced from France. At nineteen years of age he began the study of 
medicine with Dr. Nicholas Belleville, of this city, attended the 
required course at Yale College and graduated in 1829. He read a 
thesis the subject of which was " Similarity of the Nervous and Gal- 
vanic Fluid,*' a matter little investigated at that time, before the 
•assembled professors and examiners appointed by the State Medical 
Society. Prof. Silliman strongly advocated the theories of the thesis. 

After graduating he spent nearly two years in Philadelphia and 
then removed to Burlington County, where he spent six years in 
•country practice. During this time he delivered lectures on natural 
philosophy, chemistry, vegetable physiology and phrenology. Here 



446 MEDICAL SOCIETY OF NEW JERSEY. 

he wrote and had printed a Hudibrastic pamphlet against the Thomp- 
sonians, which seemed to have the effect in that region of quieting 
their clamorous advocates and driving away their troublesome doctors*. 
The pamphlet was called " Number Six ; or The Thompsonian Con- 
ferring the Degree of Steam Doctor on Some Simons, with Practical 
Advice." He returned to this city in 1837 and continued in active 
practice of his chosen profession up to the time of his death. He 
was a general practitioner and his patients were among those of the 
first position and intelligence, but the ignorant and the poor, equally 
with the intelligent and the rich, received his service, for his wisdom 
and skill was alike at the call of all. Though a general practitioner 
with a very large practice and a large consulting practice, he was 
better known as a surgeon. He was fond of that branch of his pro- 
fession and was quick to respond to a call for an operation, but to the 
sick he was often inexcusably slow in responding to calls and neglect- 
ful in his attendance. He was a good surgeon and for a number of 
years did almost all the surgery in this city and vicinity. He was 
held in high esteem by his brother physicians for his professional 
ability, as a genial companion, a kind and sympathetic friend, posessed 
with an inexhaustable fund of humor and anecdote. 

His papers to the State Medical Society and to this society show 
original thought and great industrial research. In 1853 he read a 
paper before the New Jersey State Medical Society on " The Effects 
of Mercurial Preparations on the Living Animal Tissues." and in 
1865 on ** Malaria." Many papers have been read by him before this 
society on practical surgery. He contributed a series of articles pub- 
lished in Beecher's Magazine, of natural and artificial mechanism, 
making in all a good-sized volume. In 1841, while physician in the 
State Prison, he conceived a new plan of forced ventilation of public 
buildings to drive the circulation of hot air by a blowing fan. The 
former plan of heating the building was by hot water circulating 
through the ranges of the cells ; heat, without ventilation, radiated 
from hot pipes, making the cells offensive. The plan was approved 
and the legislature appropriated $5,000 for the purpose. The appar- 
atus was constructed and worked successfully, and this is the plan by 
which all ventilated and well-warmed buildings are now managed. 
Almost as soon as electro-plating was made known to the public, he 
conceived the idea of applying the process to forming raised cuts to 
be used after the manner of woodcuts in printing. He was the 



REPORTS OF DISTRICT SOCIETIES. 44/ 

originator of a plan for firing large ordnance, such as fifteen or twenty 
inch guns, by a central chamber on which the ball rests, with the 
main charge of the powder around the chamber, so that it cannot 
take fire until the inert ion of the heavy ball has been overcome by its 
lift from its bed. Commodore Robert F. Stockton, who led the way 
in heavy guns as well as steam war vessels, when the result of the 
adoption of this plan to a fowling-piece was named to him, said it 
was the only method by which good, quick powder could be used in 
heavy cannon. The late John A. Roebling and Mr. Edwin Stevens 
also approved of this plan. 

Apart from his profession and the useful allied arts, he seems to 
have ii^dulged in painting and ))oetry, especially in the earlier years of 
his life. Many of his pieces appeared in the Philadelphia United 
States Gazette, One, " The Cities of the Plains," was published as 
annonymous in a Boston collection of select poems. A ready 
sketcher, many excellent likenesses and good paintings of his early 
friends are still to be found. One, the portrait, three-quarters length, of 
his old preceptor. Dr. Belleville, would do credit to many a professed 
artist. During the .United States bank troubles, when Gen. Jackson 
made war upon it, the celebrated " Gold Humbug " caricature was 
published in New York in the style of a large fifty cent ticket. Thou- 
sands were >struck off and sent to all parts of the country, more 
profitable to himself, the publisher said, than, anything of the kind he 
had ever attempted. Another, executed when John R. Thompson 
ran for Governor of New Jersey, representing the railroads running 
over the backs of the people, contributed greatly, it was thought at 
the time, to the success of Stratton, the opposing candidate. 

He was President of the Medical Society of New Jersey in 1855, 
President of the District Medical Society for the County of Mercer in 
1849. 1868, 1869 and 1870, President of the Board of Health of 
Trenton for six years, one of the Board of Managers of the State 
Lunatic Asylum, and a member of the United States Board of 
Examiners for Pensions. 

Dr. Jared Q. Dunn came to Princeton from Washington, D. C, 
about 1838, and married a daughter of Robert Bayles, of Kingston^ 
N. J. He was a popular and skillful physician, and an active partisan 
of the Democratic party. He had a good practice and the implicit 
confidence of his patients. He was a member of the Episcopal church. 
He was elected a member of the District Medical Society for the County 



448 MEDICAL SOCIETY OF NEW JERSEY. 

of Mercer, April 24, 1849. He died in January, 1851. He was return- 
ing at night from Trenton, where he had been attending the inaugu- 
ration of Governor Fort, and on the way home, about half-way to 
Princeton, his horse, a very spirited one, ran with him and dragged 
him entangled in the sulky. He was found dead on the road, near 
midnight, and brought to Princeton and buried in the cemetery. 

Dr. John Lloyd Taylor was born in Middletown, Monmouth County, 
June 18, 181 1. He was a student in the office of Dr. Valentine Mott, 
in New York, and graduated at the medical department of the 
University of New York. He came to Trenton in 1836. and became 
one of the leading practitioners of his time in the city. He was one 
of the first to join the society, being elected at the first meeting after 
the organization of the Mercer County District Medical Society, aiid 
for many years a useful and active member. He was, for several 
years a member of the Board of School Trustees of Trenton, a mem- 
ber of the Board of Health, and for a number of years physician of 
the New Jersey State Prison. Dr. Taylor always felt a deep interest 
in his profession. He had a strong personal interest in and attach- 
ment to his patients, and was exceedingly successful in securing their 
confidence and cooperation. He was a prudent, conscientious physi- 
cian, and confidences entrusted to him were felt to be secure. He 
died from an attack of angina pectoris, March 2, 1879. 

George R. Robbins was born in Monmouth County, N. J., Septem- 
ber 24, 1808. He studied medicine with Dr. McKelway, of Trenton, 
and graduated at the Jefferson Medical College in Philadelphia. March 
2, 1837. He commenced the practice of medicine at Falsington, 
Bucks County, Pa., but after a short time, in 1838, settled at Hamilton 
Square, Mercer County, N. J., where he continued his professional 
duties to the time of his death, February 22, 1875. He was well read 
in medical and general literature and ranked among the first in his 
profession in the State. As a physician he was vigilant, successful, 
of quick preception, careful and thorough in the diagnosis of disease, 
and his care for his patients and interest in each particular case, made 
him favorably and popularly known. As a surgeon he was skillful, 
and with great coolness and nerve met the most difficult case success- 
fully. Dr Robbins was interested in matters outside of his profes- 
sion, and was an earnest member of the old Whig party. In 1854 he 
was elected to Congress from the Second District of New Jersey, 
and by a re-election in 1856. Upon the organization of the Republi- 



REPORTS OF DISTRICT SOCIETIES. 449 

can party, he served for four years with credit to himself and honor 
to his constituents. He was a man of independent action, possessed 
of clear and forcible ideas, and sought to fulfill the full duties of the 
citizen. He was elected a member of this society at its first meeting 
and resigned July 2, i860. 

Dr. John Woolverton was born near Stockton, Hunterdon County, 
N. J., on October 27, 1825, and died at Trenton, N. J., September 14, 
1888. His early life was spent upon his father's farm in Delaware 
Township, in his native county, but the avocation of a farmer not 
being altogether congenial to his tastes, he determined on securing a 
classical education. He prepared himself for the freshman class of 
Lafayette College, at Easton, Pennsylvania, which institution he 
entered when about seventeen years of age. He remained in college 
until the close of his junior year, when he left and did not return to 
graduate the following year. But the honorary degree of Master of 
Arts was conferred upon him by the college in after years. Upon 
completion of his junior year he at once commenced the study of 
medicine in the office of Dr. Foulke, at New Hope, Bucks County, Pa. 
He entered the medical department of the University of Pennsylvania 
in the fall of 1847, and graduated in .the spring of 1849. He came to 
Trenton immediately after graduating and commenced the practice of 
his profession, where he remained to the time of his death, being at 
the time of his decease the oldest member of the district medical 
society, and the oldest practitioner of medicine in continuous service 
in the county of Mercer. He always maintained an honorable posi- 
tion toward his professional brethern, was one of the most generous 
of competitors and was eminently the friend of the young practitioner, 
being always among the very first to extend a cordial welcome to the 
new comer. Alwa)s cordial and sympathetic, and possessing, as he 
did, a warm and generous heart, made him highly esteemed, both as 
a physician and citizen, and his death was regarded by his associates, 
not only as a public loss, but the loss of a personal friend as well. 

The esteem and consideration in which he was held by his profes- 
eional brethern, as well by his fellow-citizens, cannot better be illus- 
trated than by reference to the many important positions of honor 
and trust conferred upon him from time to time. He was elected a 
member of the District Medical Society for the County of Mercer, 
April 23, 1850, and in 1853 was elected President of the society. He 
was a Fellow of the State Medical Society, being elected its President 



450 MEDICAL SOCIETY OF NEW JERSEY. 

in 1862. In 1868 he was elected, by a handsome majority, State 
Senator from Mercer County, his competitor being one of the best- 
known and highly-respected citizens in the county. He refused a 
second nomination, though urgently requested to do so. In 1886 
he was elected Mayor of the city of Trenton. He served the city for 
several years ably and faithfully in the school board as a trustee, and 
the county in the Board of Chosen Freeholders, and for a considerable 
time, prior to, and up to the time of his death, was a zealous and 
faithful member of the Board of Health. For many years he was one 
of the most prominent, as well as one of the most earnest and enthusi- 
astic members of the Masonic Fraternity in the State, attaining to the 
thirty-third degree and filling the highest positions in the gift of that 
organization. 

Dr. W. W. L. Phillips was born February 29, 1829, on a farm in 
what was at that time Hunterdon County, but which, upon the forma- 
tion of Mercer County, was included in it. In 1840 he attended a 
private school near Princeton, his instructor being the late James S. 
Green, Esq. He was not able to pursue his studies with the stead- 
fastness which his studious nature desired, for much of his time out 
of school hours was taken up with the numerous chores that inevit- 
ably devolve upon a farmer's boy. Notwithstanding the disadvantages 
under which he secured his preparatory education, he entered the 
sophomore class at Princeton in 1843, being then nineteen years of 
age. From Princeton he graduated in 1848 and at once entered 
Jefferson Medical College, from which he took his degree with high 
honors in 1851. He began to practice in Trenton immediately after 
his graduation. 

When Dr. Phillips entered upon his professional career the sick of 
Trenton, then a city of eight thousand inhabitants, were cared for by 
six physicians. At the time of his death, forty-four years later, 
during all of which time, with the exception of a short interval, he 
remained in active practice, the population had increased to sixty-five 
thousand, with nearly one hundred physicians to care for their 
physical ills. At the breaking out of the War of the Rebellion Dr. 
Phillips volunteered his services in response to a call of his country in 
its need. For upwards of four years he remained in the army, first 
as surgeon of the First New Jersey Cavalry, and subsequently as 
Surgeon-in-Chief of Sheridan's Cavalry Division. He served with 
high credit, and while his deeds of valor were not amid the clash of 



REPORTS OF DISTRICT SOCIETIES. 45 1 

arms and the roar of cannon, the call of duty ever found hin) ready 
and faithful beside the wounded and suffering, many of whom still 
live in grateful remembrance of the ministrations of his skill and 
knowledge. At the close of the war Dr. Phillips returned to Trenton 
and resumed his practice, which soon became large. In 1870 the 
effects of the exposure and work to which his army life had subjected 
him made their impression even upon his almost gigantic physique. 
His health gave way and for a year he was unable to attend to the 
duties of his profession. Upon the gradual restoration of his health, 
however, he resumed the work of which he was so fond, and in a 
short time had built up for himself a very large practice among the 
most influential families of the city. 

Dr. Phillips, from the first, went about his work with that zest and 
spirit born of a love of his calling, and to this is largely due the 
marked success which was his. A careful student and great reader, 
his success never deceived him or led him to think he had no more to 
learn, for up to the time of his death he was continually adding to 
his store of knowledge. His library, perhaps the largest private col- 
lection of medical works in the State, was selected with care and even 
with the thought that the physician to be useful must acquaint him- 
self with the steps which medical science is constantly taking into 
new and broader fields. 

In his manner. Dr. Phillips was brusque, and to those who did not 
know him well, at times seemed needlessly rough, but this very 
characteristic tended to instill in the hearts of those to whom he 
ministered, a confidence and trust so essential to a physician's success. 
To those who knew him he was the very soul of gentleness, and his 
seeming roughness was only an awkward covering for a firmness and 
•decision from which no appeal could be taken and which is as neces- 
sary a characteristic in the physician as is confidence on the part of 
the patient. He was a member of the Mercer County Medical Society, 
and at various times occupied positions in it. He was Treasurer of 
the New Jersey State Medical Society for many consecutive years. 
His eminent fitness in his chosen profession was recognized by his 
appointment as Pension Examiner during the administrations of 
Presidents Grant, Hayes, Arthur and Harrison, and by the selection 
of him as official examiner for many of the strongest life insurance 
•companies. 

Nor was it alone in the practice of medicine that Dr. Phillips held 



452 MEDICAL SOCIETY OF NEW JERSEY. 

the esteem and confidence of those who knew him. For nine con- 
secutive years he was sent to Common Council as Republican repre- 
sentative of the second ward. Twice he was unanimously selected 
as President of that body, and at the expiration of his last term he posi- 
tively declined re-election, although strongly urged by his constituents^ 
His councilmanic incumbancy was mainly devoted to the sanitary inter- 
ests of the city, and largely to his careful study and untiring efforts i& 
Trenton's now admirable system of sewerage and draining due. Dr. 
Phillips was also a member of the Board of Trade of Trenton and 
President thereof. For eighteen years he served as surgeon for the 
Pennsylvania Railroad, holding the position until his removal from 
Trenton necessitated his relinquishing it. For many years he was 
physician to the New Jersey State Prison, and by Governor Ludlow 
he was appointed a trustee of the school for deaf mutes, at Trenton. 

In his public life, as well as in the private practice of his profession^ 
the sound judgment and equitable dealing which characterized his 
actions, found for him the confidence and esteem of even his political 
adversaries. He was public spirited to a degree and ever keenly 
appreciative of whatever was to the best interest of the community. 
In his later years much of his time and attention were given to the 
organization of a hospital in Trenton, and upon the completion of the 
Mercer Hospital, which owes to him a fair measure of the credit of its 
existence, he felt that the consummation of a projebt dear to his 
heart for many years had at last been reached. 

On February i, 1896, Dr. Phillips left Trenton to assume the duties 
of surgeon at the southern branch of the National Home for Disabled 
Veteran Soldiers, at Hampton, Virginia. In his work in connection 
with the organization of the Mercer Hospital, Dr. Phillips had made 
a careful study of the most modem and best approved ideas in hospi- 
tal practice, and these he put into operation in the hospital at the 
soldiers* home, with the result that in the thirteen months of his in- 
cumbancy as head of that institution, it had been wonderfully im- 
proved and its efficiency very materially augmented. On April 10, 
1896, Dr. Phillips was taken sick. Erysipelas set in» and after an ill- 
ness of only a week he died, April 17. 

Honest, upright and conscientious in all his dealings, a power in the 
knowledge and skill of medicine and surgery, kindly and sympathetic 
in his administrations to the sick and suffering, Dr. Phillips was a 
credit to the profession in which he deservedly attained so exalted a. 
position. 



REPORTS OF DISTRICT SOCIETIES. 453 

Edward Ingleton Grant, M.D., son of William and Martha R. 
Grant, was born in the city of Trenton, Mercer County, New Jersey, 
on November 11, 181 2, and died in the same city on March 13, 1871. 
He received bis preliminary education in Trenton and then entered 
upon his college course in Princeton, New Jersey, and graduated with 
honor in 1833. He pursued his medical studies with Dr. James L. 
Clarke. He entered the University of Pennsylvania and received his 
medical degree in 1837. He at once entered upon the practice of 
medicine in the city of his birth, where he pursued his profession up to 
the time of his death. 

Dr. Grant was successful and popular as a physician, not by any 
effort at show or fictitious brilliancy, but by close study and careful 
investigation of every case which he treated. When a patient was 
placed in his charge he deemed it to be a sacred duty to bestow con- 
stant and unremitting attention to the case, bringing all his knowledge 
and scientific acquirements to the relief of the sufferer, as he recognized 
and ackowledged to the fullest extent the responsibility which a 
physician assumes when human life is placed in his hands. 

Feeling thus, he was careful to keep pace with the progress of the 
science of medicine and to make himself thoroughly acquainted with 
medical literature and the discoveries of the age. In this manner he 
qualified himself for the performance of his duties and gained, as he 
merited, the entire confidence and heartfelt love of those who placed 
themselves under his care. In all matters he faithfully followed his 
conscientious convictions of duty, regardless of the sacrifice of self 
which such a course might require. Fearless and firm in his views 
upon all subjects, still he was always gentle and considerate in the 
expressions of those views, ever regarding with great care the feelings 
of others who might hold different opinions, and ever careful to avoid 
giving offense. Naturally reticent and of a quiet disposition, he pos* 
sessed, in a remarkable degree, those virtues of character so essential 
to a physician — silence and circumspection. No professional secret 
ever escaped his lips; the follies and weaknesses of his patients^ 
which sickness so often betrays in frail human nature, were never 
made known by him. So, that all who trusted him never had cause to 
regret the confidence reposed in him. 

He was an active Christian, ever ready to perform those duties 
which the love of Christ devolved upon him. But what he did and 
what he bore was done and borne quietly and unobtrusively, as he 

29 



454 MEDICAL SOCIETY OF NEW JERSEY. 

preferred to have the substance rather than the form and show of 
godliness, thus illustrating the bounties of the Christian character 
more by practice than profession. He was a member of St. Michael's 
Episcopal Church, of this city. For many years Dr. Grant was sub- 
ject to severe and prolonged attacks of inflammatory rheumatism, 
which caused very great cardiac disturbance and eventually his death. 
During his last illness, which was many weeks, his suffering from 
pain, dyspnoea and insomnia was distressingly severe, yet during all 
these weary days and nights of agonizing pain and suffering, no 
impatient word escaped his lips, but he bore his trials and afflictions 
with calm resignation, patience and true Christian fortitude. 

Dr. Thomas Johnson Corson was bom at New Hope, Bucks County, 
Pennsylvania, February 12, 1828, and died at Trenton, N. J., May 10, 
1879. His father, Richard D. Corson, M.D., was a physician of emin- 
ence and was highly esteemed, not only by those who csgne under his 
professional care, but also by his professional contemporaries, who 
frequently sought him as counsellor in cases of difficulty and doubt. 
His mother, Helen S. Johnson, was the daughter of Thomas P. John- 
son, Esq., an eminent lawyer and judge in New Jersey. Dr. Corson 
received from his grandfather those impressions in his early life which 
stimulated his intellectual growth and gave character to his subse- 
quent professional career. He received his early education in the 
schools of his native town and in Lambertville, N. J., where, under 
the guidance of the Rev. P. O. Studdiford, D.D., he received his 
classical education. In 1848 he commenced the study of medicine 
with his brother-in-law. Dr. Charlers Foulke, in New Hope, who 
had succeeded his father and brother, both deceased. 

After attending the required course of lectures in the University of 
Pennsylvania, he graduated in 185 1 and located for practice at Jones- 
ville, in the coal regions of Pennsylvania. This field not proving 
congenial to his taste he removed to Morrisville, Pa., and after a brief 
residence there came over the river to Trenton in 1854, and entered 
upon the duties of his profession with enthusiastic zeal. In a short 
time he became one of the leading and most popular physicians of 
his adopted home. On October 17, 1854, he was elected a member of 
the District Medical Society for the County of Mercer, and at various 
limes filled nearly every office in the society. In 1868 he was elected 
President of the State Medical Society. 

As a physician. Dr. Corson was energetic and progressive, keenly 



REPORTS OF DISTRICT SOCIETIES. 455 

alive to the responsibilities of his calling and ever in sympathy with 
those whose physical suffering brought them under his care. It was 
not alone as a physician that Dr. Corson was esteemed. Positions of 
honor and responsibility were awarded him. He was elected for four 
successive years, from 1863, to the office of Superintendent of Public 
Schools of the City of Trenton. In 1867 he was chosen to represent 
the Trenton District in the State Legislature. He was for four years 
physician to the New Jersey State Prison. 

Dr. Corson led a busy life, both mentally and physically. In his 
early manhood he connected himself with the Masonic Fraternity and 
for twenty-five years was one of the leading spirits in all branches of 
the order. He filled most of the higher official positions in the order 
and at the time of his death and for many years previous had been 
Grand Secretary and Grand Recorder, respectively, of the Grand 
Chapter of Royal Arch Masons and Grand Commandery of Knights 
Templar of New Jersey. He was also for many years chairman of 
the Committee on Foreign Correspondence in both these bodies. It 
was in the latter capacity that he was called upon to perform a vast 
■amount of labor, >yhich he continued to execute till near his death 
and after he had almost entirely lost his powers of locomotion, and 
when he was obliged to employ an amanuensis. His name and fame 
as a Masonic writer and scholar were not circumscribed by narrow 
limits. Throughout the length and breadth of the country his reports 
were sought after and read with avidity, and it can be truly said that 
he won the admiration and secured the esteem of his brethren 
throughout the land. 

Dr. Corson died of a disease of the spinal cord — locomoter ataxia 
— which commenced about six years before his death. At times 
through this long period his sufferings were intense, but he bore them 
"With a Christian resignation and cheerfulness, though he well knew 
that the day of his earthly probation was drawing near to a close. On 
the thirteenth of May, 1879, accompanied by a large concourse of 
-sorrowing relations and friends, his mortal remains were conveyed to 
their last resting place near his native village and there deposited 
with the honors of the fraternity he had served long and loved so well. 

Dr. Charles Skelton was bom on a farm in Buckingham Township, 
Bucks County, Pennsylvania, April 19, 1806. His father, John Skelton, 
owned a farm of sixty acres which he cultivated in summer and in 
-winter taught a small school in order to provide for a family of ten 



456 MEDICAL SOCIETY OF NEW JERSEY. 

children. His mother, whose name before marriage was Leah Doane, 
was a woman of strong intellectual powers and with a kind and a£Fec- 
tionate disposition united with decicied religious convictions. She 
taught him in his early years of God, and instilled into his youthful 
mind that love of truth and right and purity which ever characterized 
his life. Spending his early years upon a farm, his youthful education 
was limited to reading, writing and arithmetic. For several years he 
had a very toilsome life, working at farming and quarrying at very 
low wages, having been called by the death of his father to take the 
place of the head of the family and support an invalid mother and 
two younger children. He afterwards learned the trade of a ladies' 
shoemaker, serving a three years' apprenticeship in the city of 
Trenton, and devoting his leisure time to useful reading. He found 
the small library then in Trenton — the Apprentice's Library — very 
useful in furnishing instructive reading. 

Some time after finishing his apprenticeship the strong desire for a 
higher education which he had long cherished led hipi to decide upon 
studying for a profession. His first inclination was to qualify for the 
ministry, but in looking into the creeds none seemed to entirely suit him. 
Being unwilling to speak part of the truth at the cost of suppress- 
ing other parts, and not thinking the world would be particularly 
benefited by the addition of a new "sect" to the many already existing, 
he abandoned all idea of entering the ministry. The profession of 
law next claimed his attention, but on reflection, this seemed to pre- 
sent more difficulties than theology. He thought a lawyer would be 
required to defend his clients, right or wrong, and the sacred love of 
truth which his father had instilled into his mind, made him shrink 
from a profession which, to his mind, seemed to require for its success- 
ful prosecution, the sacrifice of truth. Next came the profession of 
medicine, and this presented, to his mind, a great attraction. The 
relief of suffering humanity from disease and pain seemed to him 
truly noble, and he decided to prepare himself for the profession. 

Deeming a knowledge of Latin necessary for a physician, he entered 
Trenton Academy, supponing himself by working at his trade of 
^hoemaking. But happening to read a lecture by Dr. Rush that the 
knowledge of the Latin language was not essential to a good physi- 
cian, he concluded to go to Philadelphia and pursue the study of 
medicine at once. But he found the expenses of entering the college 
was more than he could command ; temporarily abandoned the pro- 



REPORTS OF DISTRICT SOCIETIES. 457 

ject; returned to Trenton to carry on his trade. Here, in 1829, he 
married Miss Elizabeth Hutchinson, with whom he spent forty-six years, 
loving and beloved. After, a severe struggle, untiring industry and 
frugality were crowned with success, that at the end of seven years 
he found that they had saved two thousand dollars. During all this 
time he had been spending his leisure hours in assiduous devotion to 
medical and other studies, and still had a strong desire to enter the 
medical profession. In the fall of 1835 he moved his family to Phila- 
delphia and entered as a regular student at Jefferson Medical College, 
where he graduated in 1838. Increased cost of living and the sup- 
port of an invalid mother, made it a serious question, a year after 
commencing, whether he should continue to pursue the studies, and 
for two years he was compelled to earn his living by working at his 
trade. Only the hours absolutely required for sleep were taken from 
incessant study and labor. When he received his diploma he was 
entirely destitute of funds and was suffering from impaired health 
from overwork. 

He commenced the practice of medicine in Philadelphia, but found 
that his patients brought him no money, and he again resorted to his 
trade for a living, working on the bench in the intervals between 
visiting his patients, of whom he had plenty, but from whom he 
received no pay. In eighteen months' practice he received twenty- 
five cents and a pair of boots as the reward of his professional labors. 
He concluded that a starving M.D. was not a whit more respectable 
than a prospering mechanic, so he decided to throw physic to the 
dogs and to return to his mechanical trade. In 1841 he again moved 
to Trenton and opened a ladies' shoe store in connection with the 
sale of drugs and medicine. Here he was again drawn into the 
practice of medicine among the poorer classes, for whom he had 
great sympathy, but from whom he received no pay. After furnish- 
ing medicine and other necessities for the sick, he was obliged to 
abandon the business altogether in order to gain a support for his 
family by his shoe business. 

In the spring of 1842 he was elected one of the three school com- 
mitteemen for the township of Nottingham, now a part of this city. 
At that time the State had no free public schools. Charity schools 
were opened only to the destitute in various parts of the State. The 
State appropriation to the township having about eight hundred child- 
ren was only one hundred and sixty dollars, and only a like amount 



458 MEDICAL SOCIETY OF NEW JERSEY. 

was allowed by law to be raised by taxation. The Doctor took an 
earnest part in establishing a free public school, and after great 
opposition and two years of active labor, the committee established a 
free public school for the township, the first school organized on this 
system in the State. This school was built on Centre street (then 
Nottingham Township), on the lot where the three-story brick build- 
ing now called the Skelton School — named after him— stands. In 
1847 he moved into the city proper and in the following year was 
elected the first school superintendent of the city under the new law. 
Here, largely by his efforts, the city schools were organized on the 
free system, and the public school system of New Jersey owes much 
to the early and persistent efforts of Dr. Skelton, who was its pioneer. 
About this time the Doctor took an active part in measures for the 
improvement of the condition of the working classes. Many children 
were employed in the cotton mills from early morn till eight o'clock 
at night, not receiving pay enough to furnish the food and cloth- 
ing necessary to keep them in health. A small society of working 
Hien was formed to secure laws for their better protection. Among 
these were the ten-hour law, a law forbidding the employment in 
factories of children under a specified age and that those employed 
should have at least three months' schoohng in each year. Free 
public schools and the exemption of $200 worth of household goods 
from seizure for debt were also incorporated in the platform. To 
all of these measures Dr. Skelton gave his earnest and untiring efforts. 
After four or five years of persevering labor they at last succeeded in 
electing one man to the legistature on their ticket. The Whigs had 
for years control of the State and needed no new alliance. The 
Democrats, being in the minority, were ready to secure new friends, 
and planted their party squarely on the workingman's platform, went 
vigorously to work in the contest and came out victorious. The 
legislature of 1850 and 1851 enacted these reform measures into laws, 
and to Dr. Skelton largely is due the credit of securing this beneficent 
legislation. 

, His sympathy for the toiling classes, his identification with their 
interests and the perfect confidence which was reposed in his integrity, 
together with his unbounded popularity, secured to him unsought the 
Democratic nomination for Congress, in 1850, from the second 
Congressional district. He accepted the nomination on the express 
condition that he would not be required to furnish any money to carry 



REPORTS OF DISTRICT SOCIETIES. 459 

on the campaign, and although it was deemed almost impossible to 
overcome the majority in the district, the people's champion was 
elected by a majority of nearly i.ooo. In Congress as well as else- 
where. Dr. Skelton was true to the interests of the working people, 
always sustaining their rights and advocating their cause. The 
Homestead bill elicited his earnest sympathy and hearty support 
Twice the office of Governor of New Jersey was within his reach had 
he chosen to grasp it. 

Dr. Skelton served the city in its Common Council and as its Presi- 
dent with honor and fidelity. He was a member of the District 
Medical Society for the County of Mercer from April 17, 1855, to the 
time of his death. May 20, 1879. ^^ ^^^^ ^^ earnest interest in its 
work and an active part in its dehberations. He was a diligent 
reader on all scientific subjects, and in 1875 published an *' Essay on 
Heat, Light, Electricity and Magnetism," which manifested original 
thought and attracted much attention. Later he published a pam- 
phlet on " The Doctrine of the Immortality of the Soul, sustained by 
Modern Scientific Discoveries," an essay eagerly sought for by 
thinking men in all parts of the country, and the crowning act of his 
life, as proving his love, honesty and sincerity in his eloquent plead- 
ings for the rights of the poor, in giving his library and the interest of 
all his hard-earned property to increase it, for the benefit of the poor 
of the city for all time to come. 

Dr. Edmund Hance was the son of William and Ann Hance. He 
was born January 16, 1 816, in Philadelphia, Pa., and died at Glassboro, 
N. J.. November 29, 1872. He entered the ministry of the M. E. 
Church (Philadelphia Conference) but subsequently read medicine 
and graduated at the Jefferson Medical College of Philadelphia, Pa., 
in 1854. He settled in practice in Morrisville, Bucks County. Pa., in 
1854, and in 1855 came to Trenton, was elected a member of this 
society April 17, 1855, and continued in practice here until the spring 
of 1862, when he returned to the Methodist ministry (New Jersey Con- 
ference), but in 1865 he resumed the practice of medicine in Glass- 
boro, N. J., and continued to practice there until the time of his death. 
He was President of this society in 1857 and 1858. At a meeting of 
this society held December 3, 1872. Dr. James B. Coleman offered the 
following resolutions, which were adopted : 

Resolved^ That the District Medical Society of Mercer County 
have heard with regret of the death of Dr. Edmuud Hance, their old 
associate and former President, and as a mark of high esteem with 
which the deceased was regarded by them, be it further 



46o MEDICAL SOCIETY OF NEW JERSEY. 

Resolved, That the members of the society attend the funeral of the 
deceased tomorrow at ten o'clock, at the State Street M. E. Church. 

He was a man of more than ordinary mind, of high character and 
an excellent physician. 

Dr. Joseph L. Bodine was born in Pemberton, Burlington County, 
N. J., June 26, 1839, and died in Trenton, January 2, 1888. In 1851 
his farther, Daniel Budd Bodine, having been appointed Clerk in 
Chanqery, removed his family to Trenton. Dr. Bodine received his 
preparatory education at the Trenton Academy. He entered Prince- 
ton College in 1858 and graduated in i860, after which he spent one 
year in teaching in Virginia. He studied medicine with his uncle. Dr. 
George F. Fort, entering the medical department of Pennsylvania in 
1862, and receiving his diploma in 1865. He was appointed resident 
physician of the Episcopal Hospital in Philadelphia. At the expira- 
tion of his term he was appointed assistant physician at the New 
Jersey Asylum, but after a brief *period he resigned the position and 
began the practice of medicine in Trenton, where he continued until 
his death. He was slow in gaining practice but when once gained he 
held it, and at the time of his fatal illness he had a practice equal to, 
if not the best, in the city. In 1882 and 1883 he was appointed a 
commissioner of the State Sinking Fund and rendered excellent and 
efficient service, and his reports were models of accuracy. In 1884 he 
declined a reappointment though strongly urged to accept. 

For years he was connected with St. Francis' Hospital, and his 
skill and services in that institution will be gratefully remembered. 
He was a member of the State Sanitary Society and at one time its 
President. He was State Prison physician for three years. He 
was often asked, from his well-known interest in all questions, 
to fill public positions of trust and honor, but his aversion 
to politics led him, in almost every instance, to modestly decline. His 
relations with his medical brethem were always honorable, and he 
was frequently consulted by them, for his knowledge and skill were of 
a high order. He gave every case committed to his care careful and 
thorough consideration, and was at all times ready to give a reason 
for his opinion. In all his dealings with physicians, patients or the 
public, he was honest, just, candid and considerate. 

Dr. Charles F. Deshler was born in Northampton County. Pennsyl- 
vania, October 21, 1843. While a student at Lafayette College in 
1863 he enlisted as a private in Company D., Thirty-eighth Regiment, 



REPORTS OF DISTRICT SOCIETIES. 461 

Pennsylvania Volunteers, but being transferred to the medical service 
he graduated from the medical department of the University of Penn- 
sylvania in 1865. He received a commission as acting assistant 
surgeon of Volunteers and served at Fortress Monroe and Newport 
News until September, 1865, when he came to Perhneville, Monmouth 
County, in this State, and entered upon the practice of his profession. 
In 1868 he removed to Hightstown and on October 6 of the same 
year he was elected a member of the Mercer District Medical Society, 
and at once became an active and esteemed member, taking a promin- 
ent part in its discussions and reading interesting and valuable papers 
before the society. He was most earnestly devoted to his profession 
and was systematically preparing himself for greater usefulness in his 
profession by availing himself of the special clinics in New York and 
Philadelphia, for studying diseases of the ear and the nervous system 
and for the more efficient use of the ophthalmoscope and microscope 
in the study of disease. He was careful, conscientious and attentive 
to his patients and desirous that they should have the best treatment, 
skill and medical science could suggest. 

Dr. Deshler was highly esteemed and honored by all who knew 
him for his personal worth and admirable traits of character. As a 
•citizen he was intensely interested in all subjects calculated to promote 
the public good. As a member of the church, an earnest worker and 
-consistent Christian; as a member of the medical profession, an 
ardent and enthusiastic advocate of every effort for the prevention 
and cure of disease and for the relief of human suffering. He met 
his death in the prime of life — a life filled with active, intelligent, self- 
denying labor — from a communicable disease, the ravages of which 
he had been devoting so much of his time and talent to lessen or 
prevent. He was a member of the New Jersey Sanitary Association 
from its organization, and at his death the Recording Secretar)'. He 
was reporter of the Mercer District Medical Society in 1 877 and gave 
an extended account of diphtheria in Hightstown, and in 1878 he 
read an essay before the State Medical Society on " The Relation of 
the Medical Profession to the Public Health." He died March 24, 
1879, o' scarlet fever, after three days' illness. 

Dr. Ezra M. Hunt, the son of Rev. Holloway W. Hunt, was born 
in Metuchen, Middlesex County, N. J., January 4, 1830. After a pre- 
paratary course at the Irving Institute, Tarrytown, N. Y., he entered 
Princeton College in 1845, graduating in 1849. He shortly began the 



462 MEDICAL SOCIETY OF NEW JERSEY. 

study of medicine under Dr. Abraham Coles, of Newark, and re- 
ceived the degree of M.D. from the College of Physicians and Sur- 
geons, New York City, where he attended a full course of lectures in 
March 1852. Commencing the practice of medicine in his native 
town, in 1853 he was appointed lecturer on materia medicaand thera- 
peutics in the Vermont Medical College at Woodstock. The follow- 
ing year he was elected to fill the chair of professor of chemistry in 
the same institution, but in 1855 he decided to resume practice in 
Metuchen, where he continued an active and successful practitioner 
till he joined the army in 1862 as assistant surgeon of the Twenty- 
Ninth Regiment, New Jersey Infantry. After serving for two months, 
he was placed in charge of the Calvet Street Hospital, Baltimore, Md., 
and remained there until the expiration of his term, when he returned 
to Metutchen and once more resumed the practice of medicine.. 
During these years he had been a faithful and prominent member of 
the District Medical Society of Middlesex County, serving twice as its 
presiding officer, and representing it frequently at the State Society's 
annual meeting. 

In 1864 he was elected President of the Medical Society of New 
Jersey, of which he was an active and influential member. On- 
retiring from the presidency, at the annual meeting in 1865. he 
delivered an able and urgent address on ** Our Profession in its three- 
fold Relations, as a Science, a Business and an Art." As a Fellow 
of the society he always took a deep interest in its proceedings, con- 
tributing able papers and serving on important committees. He 
not only represented the State Society frequently at the annual meet- 
ings of other State societies, but he was elected one of the delegates- 
to the American Medical Association in 1865, 1868, 1869, 1873, 1875, 
1877 and 1879, and at the 1880 annual meeting of the National 
Association, held in New York City, he was elected one of its vice- 
presidents. The State Society also appointed him a delegate to the 
International Medical Congress in 1877, and again in 1882. 

By an act of the Legislature, in 1866, the State Sanitary Commission 
was created, in the formation of which he took an active part and was 
made.its first President. In 1874 the New Jersey Sanitary Association 
was formed as a result of his persistent and active efforts to establish a 
public sanitary system and awaken general attention to the whole 
question of public hygiene. He was one of the most useful and in- 
fluential members of the American Public Health Association, and 



REPORTS OF DISTRICT SOCIETIES. 46J 

was its President in 1883. In 1876, in company with Dr. J. S.Bellingp 
Surgeon U. S. A., he went to Europe for the purpose of inspecting^ 
hospitals and studying sanitary matters. As a result of his investtga* 
tions abroad and the deep conviction he felt of the needs of health 
legislation for our own State, the New Jersey State Board of Health 
was established in 1877, and he was chosen as the one, of all others, 
best fitted to conduct the work. This he did with such zeal, wisdom 
and faithfulness/up to the time of his death, that no eulogy can too 
highly laud his noble and self-sacrificing efforts in its behalf. He lived 
to see working efficiently, the system which, but for him, would not 
have been organized and which remains as a monument to his vigor,, 
his fidelity and his philanthropy. 

In the affairs of the State Medical Society he ever took a foremost 
and active part. His papers were numerous, able and forcible, and he 
can justly be styled one of the fathers of the society. Indeed, it is 
not too much to say that this society owes much of its success, it& 
prestige and its glory today to the wise counsel, moulding influence 
and ennobling example of Dr. Ezra M. Hunt. The degree of LL.D. 
was conferred upon him by Lafayette College, and that of SC.D. by 
Princeton. In 1888 he was elected an honorary member of the 
Epidemiological Society of London, England, a degree rarely conferred 
and only for original research and eminent ability. Besides the 
numerous and excellent articles for medical and sanitary journals 
which emanated from his pen, he was the author of several valuable 
works on these and kindred subjects, and even in his busy life as a 
public sanatarian and private practitioner, he found time to pre- 
pare and publish an excellent commentary on the old and new testa- 
ments, together with one or two other religious works. As has well 
been remarked by a recent writer in a carefully prepared sketch of 
his life : ** The secret of Dr. Hunt's life of activity, earnestness and 
perseverance, is to be found in his deep personal piety and con- 
sistent, humble Christian life, his firm unwavering faith in God." 

He united, when quite young, with the First Presbyterian Church 
of Metuchen, in which he was, for many years, until his removal from 
the place, a faithful and beloved ruling elder, and when he removed ta 
Trenton he united with the Fourth Presbyterian Church, and later 
became an elder in that church, and in his last lingering illness, which he 
bore with the greatest fortitude and cheerfulness, there was a patience 
in suffering, a submission to the Divine will, and a buoyant hope bora 



464 MEDICAL SOCIETY OF NEW JERSEY. 

of an unfaltering trust, that impressed all who had the privilege of 
knowing him intimately. His first wife was Miss Emma Ayers. of 
Rahway, N. J., to whom he was married in 1853. She died in 1867. 
He afterward married Miss Emma Reeves, of AUowaystown, N. J. 
His valuable and eminent life was brought to a peaceful and triumph- 
ant close in his old home at Metuchen, July i, 1894. His funeral 
services were conducted by his old pastor, Rev. J. G. Mason, D.D., 
and he was buried in the old family plot in the Presbyterian cemetery 
of his native town. 

Dr. Charles H. Dunham was bom in Middlesex County, N. J., on 
March 24, 1839. He came to Trenton in 1858 and entered the drug 
store of Isaac D. James, where he remained, using his spare time 
reading medicine under the direction of Dr. James B. Coleman, until 
he entered the medical department of the University of Pennsylvania, 
from which institution he graduated in 1864. Immediately after 
graduating he served ten months as assistant surgeon in the army. 
He then returned to Trenton and engaged in the drug business with 
his friend, Isaac D. James. This partnership was dissolved in 1872 
and he entered upon the practice of his profession, which he assidu- 
ously followed until his death. So devoted was he to the practice of 
medicine that he rarely engaged in any other pursuit. But once only 
was he persuaded to take a public office, and that was when he was 
elected to the office of Superintendent of Public Schools. He was 
elected by a large majority, clearly indicating the esteem in which he 
was held by his fellow-citizens. He also held the position of county 
physician which he filled with great ability. The position which he 
most highly prized and the one most congenial to his tastes was that 
of being a member of the medical staff of St. Francis' Hospital, of 
which he was an active member for eighteen years, resigning only 
when his health would not permit him to continue longer. While on 
the staff he rendered most efficient and faithful service. It was while 
engaged in the practice of his profession that he revealed the best 
side of his nature. True to every instinct of a gentleman he, under 
all circumstances, conducted himself in his intercourse with his 
medical brethren with fairness and courtesy. To his friends he was 
kind and generous ; to his patients, a most faithful, conscientious and 
skillful physician, endearing himself to them as few physicians ever 
succeed in doing. He died. October 16. 1895, and his many noble 
traits of character cause those who knew him ever to revere and 
cherish his memory, as well as regret and mourn his loss. 



REPORTS OF DISTRICT SOCIETIES. 465 

Dr. John Kirby was born near Swedesboro, N. J., September 13^ 
1826, and died in Trenton, of apoplexy, February 27, 1897. Dr. Kirby 
was a graduate of the University of Pennsylvania in the class of 1852, 
and practiced medicine in the city of Salem, N. J., for nearly twenty- 
five years, and during all that time, the testimony of those who knew 
him best is one of love and veneration. His patients came to look 
upon him as one of their dearest friends, and when he left his active 
practice and came to Trenton there was an universal expression of 
regret among them. In his business relations with his fellow-citizens 
he was always regarded as the soul of honor, and his reputation for 
truthfulness extended to all classes. Upon taking up the duties of 
assistant physician to the New Jersey State Hospital, Dr. Kirby 
brought to bear the very best qualifications for one assuming such an 
important position. Under the most trying circumstances he was 
brave, patient and uncomplaining. One who knew him well and was 
closely associated with him for a long time says, in writing of him : 
** I regard him as one of the most upright, honorable and altogether 
admirable men it has ever been my good fortune to meet." 

Dr. William Green was born in Nottingham, England, January 30, 
1839. In 1847 he came to America with his parents, who settled in 
Trenton and engaged in the business of bread and cake baking. 
William was sent to the Trenton Academy and from there to Prince- 
ton College, where he spent two years. He then entered the office of 
Dr. John Woolverton to study medicine, and in the fall of 1858- 
entered the medical department of the University of Pennsylvania and 
graduated in the spring of i860. He engaged in the drug business,, 
devoting his whole time to it for several years, when he decided to 
enter upon the practice of medicine in connection with his drug 
business, but after a short time relinquished the drug business and 
devoted his whole time to the practice of his profession. He was 
elected a member of the district medical society in July, 1868, and 
as President in 1 879. He took a deep interest in the society and his 
profession, in which he was actively and enthusiastically engaged 
until ill health compelled him to relinquish it. He was an early com- 
municant of St. Paul's P. £. Church, a teacher and superintendent of 
the Sunday School. 

Dr. Henry Walburg Coleman was bom in the city of Trenton, N. 
J., February 22, 1847. His father was the late Dr. James B. Coleman. 
His mother, Henrietta L. Coleman, was the daughter of the Rev. 



466 MEDICAL SOCIETY OF NEW JERSEY. 

Frederick Beasley, who for a long time was President of the Univer- 
sity of Pennsylvania. His mother was also a sister of the late Chief 
Justice Beasley. Dr. H. W. Coleman received his early education at 
the schools in Trenton. He graduated from the College of Physicians 
and Surgeons in New York when he was twenty-one years of age. 
He took up the practice of medicine here in Trenton with his father. 
At the death of his father he succeeded to his father's practice and 
continued in his profession until the year 1894, when, on account of 
ill health, he was forced to retire. He had a large and extensive 
practice, and was particularly gifted as a surgeon and was well-known 
to the legal fraternity as an expert in homicide cases. He was the 
surgeon, for a long time, of the Seventh Regiment, N. G. N. J., and 
at one time was a member of Common Council. He died in Phila- 
-delphia, on March 30. 1897, of Bright's Disease. 

Dr. James Paul, elected April 24, 1849; died November 10, 1852. 

Dr. James H. Baldwin, elected January 22, 1850; died May 2, 1869. 

Dr. Jacob Quick, elected July 22, 1851 ; moved from the county, 1877. 

Dr. John A. Johnston, elected July 20, 1852 ; moved from the 
•county, 1855. 

Dr. Barclay H inch man, elected April 17, 1855 ; moved from the 
-county, 1856. 

Dr. Charles T. Bonsell, elected October 16, 1855; expelled October 
J2, 1858. 

Dr. F. V. Dayton, elected April 21, 1857; died November i, 1866. 

Dr. Charles Hodge, elected April 21, 1857; died July 31, 1876. 

Dr. J. H. Janeway, elected April 6, 1858 ; resigned January 7, 1862. 

De. W. T. Stout, elected July 6, 1858 ; died February 26, 1862. 

Dr. O. H. Bartine, elected April 5, 1859; dropped from the roll. 
May 6, 1884. 

Dr. H. S. DeSanges, elected October 6, 1863;. moved from the 
county, 1867. 

Dr. D. P. Vail, elected July 25, 1865 ; moved from the county, 1S68. 

Dr. S. B. Conover, elected October 3, 1865 ; moved from the State, 
j866. 

Dr. R. H. Osborne, elected October 2, 1866; moved from the 
•county, 1866. 

Dr. Jacob B. James, elected October 2, 1 866 ; died December 30^ 1 88 1 . 

Dr. Patrick McCaffry, elected April 2, 1866 ; moved from the county, 
«87i. 



REPORTS OF DISTRICT SOCIETIES. 467 

Dr. John W. Baker, elected October i, 1867; moved from the 
•<:ounty, 1868. 

Dr. Jacob R. Freeze, elected February 4, 1868; resigned January 
4, 1870. 

Dr. Edward I. Welling, elected May 5, 1868; dropped from the 
roll, 1877. 

Dr. Edward H. Reed, elected October 6, 1868; died July 9, 1877. 

Dr. Herman Schafer, elected March i, 1870; dropped from the roll, 
14ovember 3, 1885. 

Dr. G. S. Meeser, elected April 4, 1871 ; moved from the county, 

1873. 
Dr. James A. Exton, elected June 4, 1872 ; moved from the county, 

'1 877. 

Dr. Austin W. Armitage, elected January 7, 1873; moved from the 
county, 1878. 

Dr. Lloyd Wieber, elected July 7, 1874; dropped from the roll, 1884. 

Dr. Joseph Von Gaskill, elected July 7, 1874; moved from the 
county, 1874. 

Dr. George R. Robins, Jr., elected September i, 1874; dropped 
from the roll, 1878. 

Dr. William Hodgeson, elected December i, 1874; moved from the 
county. 1877. 

Dr. J. R. Culbertson, elected January 4. 1875 ; dropped from the 
roll. 1875. 

Dr. Richard Thomas, elected February i. 1875; dropped from the 
roll, 1877. 

Dr. L. D. Tompkins, elected June 5, 1877. 

Dr. Charles L. Pearson, elected October 2, 1877 ; died April 12, 1883. 

Dr. Henry A. Hutchinson, elected May 7, 1878; moved from the 
county, 1879. 

Dr. Henry D. Brock, elected May 7, 1877 ; died in 1886. 

Dr. A. R. McDonald, elected September 3, 1878; dropped from 
the roll, 1 88 1. 

Dr. William A. Newell, Jr., elected December 3, 1878; moved from 
the county, 1883. 

Dr. H. A. P. Neel, elected March 4, 1879; moved from the county, 
1883. 

Dr. E. J. Bergen, elected October 7, 1879; moved from the county, 
J 879. 



1 



468 MEDICAL SOCIETY OF NEW JERSEY. 

Dr. Robert M. Rankin, elected February i. 1881 ; died October 14^ 
1884. 

Dr. Robert C. Hutchinson, elected Feb. i, 1881 ; dropped from the 
roll, 1886. 

Dr. Adonis Nelson, elected August 2, 1881 ; moved from the 
county, 1883. 

Dr. J. W. Burton, elected September 6, 1881 ; moved from the 
county, 1883. 

Dr. George E. Titus, elected March 7, 1882; dropped from the 
roll. 1884. 

Dr. Smith H. Lewis, elected August 2, 1881 ; died 1890. 

Dr. Edgar Hart, elected July 1 1, 1882 ; dropped from the roll, 1884. 

Dr. Alexander M. Stein, elected September 5, 1882 ; moved from 
the county, 1884. 

Dr. Joseph S. Lahning, elected December 5, 1882 ; died in 1890. 

Dr. O. G. Sands, elected February 5, 1884 ; resigned in 1887. 

Dr. Horace G. Wetherill, elected March 4. 1884; moved from the 
county, 1896. 

Dr. Charles R. Burroughes, elected September i, 1885; died 1897* 

Dr. H. H. Sinne, elected 1888; died 1891. 

Dr. F. Johnson, elected 1888 ; dropped from the roll, 1891. 

Dr. £. R. Gerlock, elected 1890; died 1890. 

Dr. F. H. Gale, elected 1889; dropped from the roll, 1891. 

Dr. D. B. O'Leary, elected 1892 ; moved from the county, 1893. 

Dr. £. Kelly, elected 1895 ! dropped from the roll. May 10, 1898. 

Dr. Charles B. Leavitt, elected 1882; dropped from the roll. May 
10, 1898. 



MIDDLESEX COUNTY. 

To the Chairman of the Standing Committee^ &c.: 

This has been for Middlesex County Medical Society 
a year unmarred by a single meeting except one, at which 
we elected officers, and it fell to my lot to write up the 
events of the year. From the district reports, I gather 
that the health of the county is unusually good. One 
physician reports malaria as " absolutely unkown," while 



REPORTS OF DISTRICT SOCIETIES. 469 

another says that "what few cases he has seen have been 
imported." We have not quite arrived at such a state 
of perfection around New Brunswick, but are rapidly- 
approaching it. 

The Woodbridge treatment seems to have been fairly 
successful in typhoid fever, though from these figures — 
one death in seven cases — it is not superior to other 
methods of treatment. There have been few cases of 
pneumonia, for which strychnia is given ** freely to both 
young and old " with success by one of our physicians. 

Dr. J. C. Holmes sends the following note regarding ap- 
pendicitis : " During the past two years there have been 
eight cases of appendicitis in this locality, viz.: Female, 
age 17 ; no operation ; died. Male, age 16 ; no operation ; 
died. Male, age 18; operation; died. Male, age 19; 
operation ; died. Male, age 14 ; no operation ; recovered. 
Male, age 34; no operation; died. Female, age 14; 
operation ; died. Male, age 42 ; no operation; recovered. 
Died, three cases, no operation ; died, three cases, oper- 
ation. Recovered, two cases, no operation. Of the 
three cases operated on, two were early — third or fourth 
day — and one late, about tenth day." 

In answer to the request for views concerning ** Milk 
as a culture medium and its capacity to spread infectious 
disease," Dr. Holmes sends the following interesting 
note : ** About a year ago a dairyman in Mercer County 
had a hired boy who had diphtheria, and before he 
recovered, the daughter also contracted the disease. 
During this period the dairyman made his daily trips 
from the farm to a large town in Mercer County. Over 
fifty cases of diphtheria occurred in the town, all of 
which were supplied with milk from this source. There 
had been no diphtheria in the town for ten years prior to 
this time. The boy had assisted in the milking and the 
so 



470 MEDICAL SOCIETy OF NEW JERSEY. 

daughter had had the care of the milk, which was kept 
in the cellar of the farmhouse." 

A somewhat similar occurrence took place in New 
Brunswick some years ago. A milk dealer who bought 
his milk, having it delivered at his house for transferring 
to his own cans, had scarlet fever in his family. He 
continued to sell milk about town, and in a little over a 
week from the time his children were taken sick the 
disease began to appear among his patrons, and in one 
day it was discovered in six families which were supplied 
by this man. There probably were other cases of which 
I did not learn. The disease spread to some extent, but 
the original source of infection having been promptly 

cut off, it was readily controlled. 

A. L. SMITH. Reporter. 
New Brunswick, N. J. 



MONMOUTH COUNTY. 

To the Chairman of the Standing Committee ^ &c.: 

Requests to members of this society for important or 
interesting cases and experience have elicited few re- 
sponses and nothing of sufficient interest to incorporate 
in this report. The annual meeting, held at Freehold, 
May 1 6, was well attended, and the members present 
were ably entertained by Dr. Field, who reported openu 
tions, specimens and tabulated histories on ten cases of 
appendicitis and fourteen laparotomies. Dr. Forman 
also gave histories and specimens of two cases of lith- 
otomy. Two new members were added to our ranks. 
After an elaborate collation the society adjourned to 
meet in October, at the Monmouth Memorial Hospital, 
Long Branch. 1 very much regret the absence of im- 
portant matter to make this, my first report, interesting. 

E. W. CRATER, Reporter. 



REPORTS OF DISTRICT SOCIETIES. 47 1 

SALEM COUNTY. 

To the Chairman of the Standing Committee^ &c.: 

The Salem County Medical Society has held four 
interesting meetings during the year. The progress and 
prospects of the society are favorable and the members 
seem to show much interest in the work. Friendly criti- 
cism is a feature of the meetings, tending to the mutual 
benefit of the members. Delegates from the Glou- 
cester County Society and from other medical societies 
continue their welcome visits to us, and we are also, 
sometimes, favored with the presence of noted medical 
men from Philadelphia. Diphtheria is reported as having 
been prevalent during the past winter in the southern 
part of the county, but with a low mortality. Measles, 
with bronchial complication, is reported epidemic in 
AUoway, Quinton, Salem and Pennsville. 

More than the usual number of surgical cases have 
occurred in Pennsville and vicinity. Drs. N. Hires and 
R. M. Davis joined the society during the past year. 
Dr. William S. Patrick, of Woodstown, aged 33 years, 
has been removed by death. The experience of several 
members of the society shows that milk is capable of 
spreading infectious diseases, and Dr. Davis suggests that 
care shall be taken in milking to keep the milk perfectly 
clean, and to place the milk at once in air-tight containers 
to be kept until used, the danger being thus reduced 
to a minimum. If milking is done by careful and cleanly 
people, and pure water is used for all needful purposes, 
the containers being kept fresh and being thoroughly 
cleaned every time they are used, the milk will be pure 
enough for use, providing, of course, it is taken from 
healthy cows. If it is not allowed to stand in an in- 
habited dwelling until ready for use there would be less 



472 MEDICAL SOCIETY OF NEW JERSEY. 

danger that it may act as a medium of infection. But 
milk is often allowed to stand in the room of a patient 
for hours before use. If milk was not received in dwell- 
ings containing patients affected with an infectious dis- 
ease until it is needed for immediate use, the members of 
the family who use it would be less liable to contract the 
illness. 

Much interest has been shown in the use of antitoxin 
by Drs. Carpenter, Waddington, Chavanne, and others. 
Professors B. T. Shimwell, of Philadelphia, gave the 
society valuable suggestions in reference to appendicitis 
— when to operate, etc. Dr. Halsey, of Williamstown, 
Gloucester County, read an able paper on " Sick Head- 
ache.*' Dr. Good, of Quinton, read an excellent essay on 
" The Doctor.*' A case is reported by Dr. James, of 
Pennsville, of a gunshot wound in a child eight years old, 
while in bed, the load being discharged in the room 
below — No. 4 shot penetrating through ceiling, floor 
above, a mattress and a feather bed. The discharge 
carried splinters, etc., and produced a lacerated wound 
through the muscles of the posterior portion of the thigh. 
The treatment consisted in the removal of the foreign 
bodies and in washing with antiseptics and allowing the 
wound to heal by granulation. The obituary of Dr. 
William S. Patrick, presented by Dr. W, H. Carpenter 
and received by the society, will be forwarded by the 

secretary. 

Respectfully submitted, 

H. TrjOHNSON, Reporter, 
Pedricktown, N. J. 



REPORTS OF DISTRICT SOCIETIES. 473 

SOMERSET COUNTY. 

To the Chairman of the Standing Committee^ &c,: 

At our October meeting a representative from E. B. 
Meyrowitz, of New York, gave us a demonstration of the 
X-ray apparatus and its uses. In January, Dr. C. R. P. 
Fisher, of Bound Brook, read for us a paper on ** The 
Treatment of Pulmonary Tuberculosis." Dr. Fisher re- 
ported a number of cases in which he had used the anti- 
phthisin of Von Ruck. In these cases the results had 
seemed beneficial. At our annual meeting in April, Dr. 
Ernest Laplace, of Philadelphia, gave us a practical and 
instructive talk on the •* Surgery of the Head." No cases 
of special interest have been reported during the year, 
except those of Dr. Fisher, already referred to. 

A. L. STILLWELL, Reporter. 
SOMEKVILLE, N. J., June ii» 1S98. 



SUSSEX COUNTY. 

To the Chairman of the Standing Committee, &c.: 

Only one reply was received to the circular of inquiry 
mailed to each member of our district society and in that 
reply none of the questions were answered. The society in 
Sussex county has of late years lost much of its enthusi- 
asm and the attendance at the annual meetings is scarcely 
above a quorum. An effort is being made to awaken 
more interest, and as a move toward that end a semi- 
annual meeting will be held this year. No members 
have died during the year. Our county has had no seri- 
ous epidemics, but the central and northern parts are now 
having quite an extensive outbreak of whooping-cough. 

Respectfully submitted, 

S. B. STRALEY, Reporter. 



474 MEDICAL SOCIETY OF NEW JERSEY. 

UNION COUNTY. 

To the Chairman of the Standing Committee ^ &c,: 

The general health in Union County during the 
past year has been very good. There has been less of 
nearly all contagious diseases. Typhoid fever has been 
very rare. Interest in and attendance upon the Union 
County Medical Society meetings continues excellent, as 
heretofore. During the year four regular and two special 
meetings were held. Three papers were read and dis- 
cussed as follows : " Puerperal Eclampsia,*' W. C. Boone, 
M.D.; ** Eye Disease in General Practice." W. E. Cladek^ 
M.D.; " Psycho-Therapeutics," T. H. Tomlinson, M.D. 
Members elected during year, four. Names proposed, 
pending election, two. There were two resignations and 
one expulsion. We have lost by death, two members, 
Dr. D. W. C. Hough, of Rahway, and Dr. Andrew Man- 
ning, of Plainfield. Our total membership is now fifty- 
three. At the last meeting the election of officers for the 
year resulted as follows : President, Jas. S. Green, M.D.; 
Vice-President, Edgar B. Grier, M.D.; Secretary, J. B. 
Harrison, M.D.; Treasurer, R. J. Montfort, M.D.; Re- 
porter, R. B. Whitehead, M.D. 

Respectfully submitted, 

R. B. WHITEHEAD, Reporter. 



WARREN COUNTY. 

To the Chairman of the Standing Committee, &c.: 

Very little of a startling nature has transpired during 
the past year in Warren County. But two members of 
the society have responded to the brief and neat little 
circulars sent out by your committee to the profession 



REPORTS OK DISTRICT SOCIETIES. 475 

in the State. Dr. Wm. Stites, of Washington, says that 
there is nothing better for the spreading of infectious 
diseases than milk. Dr. Frank W. Curtis, of Stewarts- 
ville, says : " Believe the greatest care should be taken 
in the use of milk, as it is a prolific source of infection.** 
He also states that he has had the usual epidemic of 
measles, mumps and " grip *' in his practice. The mumps 
were complicated with severe gastric troubles. The " grip " 
also presented the same conditions. During the past 
year there has been a mild epidemic of scarlet fever in 
Phillipsburg — forty known cases, with two deaths. Four 
cases of diphtheria, no deaths. Four cases of typhoid 
fever, one death. Our district society is in a flourishing 
condition. I present the following very interesting 
paper from the pen of Dr. J. C. Johnson, of Blairstown, 
N. J., which was read before our district society. 

Truly yours, 

J. H. GRIFFITH. Reporter. 
Phillipsburg, N. J., June 8, 1898. 



Effects of Pressure on the Heart's Action. 

BY J. C. JOHNSON, M.D., BLAIRSTOWN, N. J. 

The purpose of this paper is to consider some of the effects of 
pressure upon the heart's action caused by conditions which exist in 
the epigastric and left hypochondriac regions of the abdomen, omit- 
ting mention of that arising from causes which operate in the thorax. 
A few days ago, while listening to the heart of a patient whose pulse 
was slow and regular, I found that the pressure of my head upon the 
cartilaginous border of the ribs caused interruption, irregularity and 
at times a double beat which disappeared when the head was re- 
moved. I had noticed this occurrence before. 

A most frequent pressure is that from chronic dilatation of the 
stomach with its accompanying fluctuations. As the normal location 
of this organ is more to the left than to the right, and is in proximity 



476 MEDICAL SOCIETY OF NEW JERSEY. 

to the heart, the extent of displacement can be known only by par- 
ticular examination, for it is possible that the distended organ may 
rise to the xiphoid cartilage and may push up the left cms of the 
diaphragm to a point one and one-half inches below the nipple, or 
even as high as the nipple line. The expansion of the stomach may 
be rotund in shape or it may push upward in the form of a cone. 
An old practitioner once said that he never knew a female patient 
who did not have a pain on her left side, and if cases are examined 
minutely many a pain in the left mammary region, extending to the 
left arm and causing cardiac anxiety, may be referred to pressure 
from gaseous accumulations in the abdomen, especially when spasm 
of the cardiac orifice of the stomach hinders the free exit of the 
accumulation. 

A second distention is that of the transverse and descending colon, 
which may be excessive and which exists when eructations from the 
stomach do not give expected relief and the flow of gas seems to be 
almost continuous. In these cases the expulsion of the gas per 
rectum gives speedy relief. Another element in chronic cases is a 
paretic condition of the left crus of the diaphragm from prolonged 
pressure. This appears from the fact that palpitation, the most 
annoying symptom, is quickly relieved if the patient is able, by a full 

• 

inspiration, to press down the obtruding cause, and when this can be 
done the heart at once resumes its normal beat. 

Another symptom is where the action of the heart is irregular and 
with an accompanying dyspeptic dyspnoea, which causes repeated 
efforts to get a full inspiration and which alarms the patient by a sense 
of impending suffocation. It has occurred to the writer that this 
oppression might be explained by a temporary paralysis of the solar 
plexus caused by posterior pressure of the dilated stomach, as relief 
comes from lying on the side instead of the back. Persons who are 
constantly troubled with flatulence are also lithaemic. In a very bad 
case the urine was loaded with urates as plentiful as is seen in cases 
of acute rheumatism. 

I now consider those effects which acute congestion, causing en- 
largements of the liver, stomach and spleen, have upon the acute 
diseases of the thorax. The limitations of diagnosis of the affections 
of the thorax to physical examination of the chest organs may cut off a 
part of the pathology, and the modern assertion that micro-organic in- 
fection is a chief cause of pneumonia, pericarditis, etc., is the main thing 



. REPORTS OF DISTRICT SOCIETIES. 477 

to be considered, and that a scrum is needed to destroy the " bugs " is 
likely to keep out of view an important part of the treatment. In all 
these diseases I look into the condition of the secretory organs and 
try to restore normal action of the stomach, liver and kidneys as a 
primal necessity, and to note how soon abnormal temperature is 
reduced by a proper attention to these points and by the relief to the 
general circulation, avoiding a tendency to heart failure caused by 
conjoined abdominal and thoracic congestions. I allow that pneu- 
monia ia country practice. may be a very different disease from that 
seen in cities, but am well satisfied with the results of carrying out 
the therapeutic indications that have been given. 

Lastly, how much pressure from excessive tympanites in acute 
abdominal affections has to do with a depressed heart's action is to 
be considered. We see this in cases of infants who are what the old 
mothers called " livergrown." The distended abdomen rises over the 
margin of the ribs and there is also much tenderness on pressure, 
while at the same time a concealed pneumonia is present, which 
causes the rapid breathing and rapid pulse. Also the very excessive 
tympanites seen in acute general peritonitis, and so fatal a symptom 
that it is questionable whether abdominal section should not be 
resorted to. Localized swelling in appendicitis is not as serious as 
that which comes on when the peritonitis becomes general. 

A more successful treatment of this grave symptom is needed. 
Dr. Levis once advised puncture by aspirating needles, but this treat- 
ment has not been followed since his time. The treatment of these 
chronic dilatations and co-existing conditions is a frequent demand 
upon our skiH. The remedies for relief of the oppressed heart are the 
carminatives, spirit of ammonia, chloroform water. Spirit of camphor 
■given often in small doses is most effective in expelling flatus by the 
rectum. In an urgent case where death seemed imniinent, a hypo- 
dermic of morphia and atropia gave relief by relaxing the spasm of 
the cardiac orifice, which allowed free exit of an enormous amount 
•of gas. 

For more permanent relief — treat the condition of the stomach 
-which is almost always catarrhal — calomel in small doses dissolves 
the mucus which hinders the access of the food to the inner coat of 
the stomach. Hyd.-c. creta. can be used longer for the same purpose. 
For atony of the stomach and bowels, strychnia and bitter tonics, 
properly given, are the best. Intestinal antisepsis includes the use of 



478 MEDICAL SOCIETY OF NEW JERSEY. 

creosote, guiacol, menthol, resorcin, salol, napthol in its numerous 
combinations ; but all these are, like the pepsins, to be renewed indefi- 
nitely. The lithaemic state must be treated in its multiple forms. 

Constipation is treated according to its varying causes. The aloin 
strych. and belladonna pill is used extensively but it has its limitations 
as to the frequency of the dose. Keeping in mind the fact that a free 
flow of bile is the best and natural antiseptic, the remedies that pro- 
mote that are to be used. Besides the mercurials already alluded to 
to relieve congestion of stomach and liver, and old combination pill 
aloes, which contains aloes, rhubarb and ext. gentian with oil of cara- 
way, causes easy motion of the bowels and has a quick effect in re- 
lieving flatulence and stopping the reproduction of it, and the dose 
can be given with no fear of unpleasant action of any ingredient. 

Another simple remedy is to give before breakfast a teaspoonful of 
sulphate of magnesia in half a glass of cold water, adding eight drops 
of tinct. nux. vomica — the bitter taste of the latter hides the un- 
pleasant one of the salts. This makes a gentle and efiFective laxative 
and washes out the stomach. Tinct. myrrh, in doses of fifteen drops 
in water before meals, is to be given steadily. It is astringent tonic 
and antiseptic, and is to be used for a lon^ period. Lastly, we recur 
to the fact that any remedy which contributes to a free portal circular 
tion and thus relieves pelvic congestion ; and that piles and enlarged 
prostate, and the pelivc congestions in the female are to be helped by 
remembering this idea. 

In the discussion which followed the reading of this 
paper, Dr. Van Syckle spoke of the use of fel. bovis and 
its congeners as effective in stopping flatulence. This is 
confirmatory of the above stated idea that a free flow of 
bile is the best intestinal antiseptic. 



CONTENTS. 



PAGE. 

OFFICERS 6 

FELLOWS 7 

HONORARY MEMBERS 9 

PERMANENT DELEGATES lo 

MEMBERS OF DISTRICT SOCIETIES 13 

SUMMARY OF MEMBERS 29 

MINUTES 31 

APPENDIX TO THE MINUTES— 

Report op Corresponding Secretary 93 

Report of Treasurer 97 

Report of Committee on Business 98 

Report of Committee on Honorary Membership 99 

Report of Standing Committee 100 

Report of Delegate to the New York State Medical 

Society 105 

Paper read by Dr. Henry Mitchell, on " Progress in Pub- 
lic Hygiene " 106 

Paper read by Dr. Edward L. Bull, on "Progress of 

Ophthalmology and Otology" 114 

Paper read by Dr. Charles Young, on " Progress in 

Surgery " 124 

Paper read by Dr. E. Fayette Smith, on "The Year's 

Progress in Diseases of the Nose and Throat" 141 

Paper read by Dr. B. Meade Bolton, on "Progress in 

Bacteriology" 144 

External CEsophagotomy ; Report of an Operation for 
Impacted Foreign Body in the CEsophagus located 

by the X-Ray," by John C. McCoy, M.D 152 

Report of a Case of Lumbar Nephrectomy, by John C. 

McCoy. M.D 169 

Report of a Case of Foreign Body in the Bronchi; 

Tracheotomy, by Walter B. Johnson. M D 174 

Opening of Discussion on " Milk as a Food and as a Means 
OF Contagion." by Richard Cole Newton M.D 176 



48o CONTENTS. 

PAGE. 

" Milk," by John L. Leal, M.U 184 

Address of the President, by David C. English. M.D 193 

Essay, "The Umbilical Cord," by William Pierson, M.D 341 

Essay, "Uterine Displacements." by H. B. Costill, M.D 361 

Essay, "School Hygiene, with Reference to the Pro- 
duction OP Ocular Disease," by Walter B. Johnson, M.D. 273 
Essay, " Regression vs. Progression. Viewing the General 
Practitioner from a Scientific Standpoint," by J. C. 

Applegate, M.D *. 389 

Essay, "Chronic Cardiac Disease and its Management," 

by Louis Faugeres Bishop, M.D 897 

Essay, " The Dangers op Certain Faulty Impressions Rb- 

. garding the Menopause," by Philander A. Harris. M.D... 3x7 
Essay, "Early Diagnosis and Treatment of Pott's Dis- 
ease," by S. A. Twinch, M.D 327 

Essay, "Recent Advances in the Normal and Pathological 
Histology of the Central Nervous System," by Fred'k 

R.Bailey,M.D 339 

OBITUARIES— 

In Memoriam 360 

Henry Ely Branin. M.D 363 

Orange W. Braymer, A.M., M.D., Ph.D 365 

Jonathan Sheppard Whitaker, M.D 366 

Henry Gaylord Buckingham, M.D 368 

John James Hbroby Love, M.D 369 

Henry Bedell Crane. M.D 373 

John Duane Brumlby. M.D 373 

Thomas Hanlon Atkinson. M.D 375 

Isaac N. Quimby, M.D 376 

Chas. Richard Burroughs, M.D 378 

Joseph R. S. Farrow, M.D 379 

W. S. Patrick, M.D 380 

Dewitt Clinton Hough, M.D 380 

Andrew Manning, M.D 381 

REPORTS OF DISTRICT SOCIETIES- 
ATLANTIC COUNTY, Report by William Edgar Damall. M.D. 385 

Pneumonia and Abortion, by J. A. Joy, M.D 386 

Hydrophobia, by William Edgar Damall, M.D 387 

BURLINGTON COUNTY. Report by Joseph Stokes, M.D 390 

CAMDEN COUNTY, Report by John G. Doron, M.D 392 

CAPE MAY COUNTY, Report by John S. Douglass. M.D 407 

CUMBERLAND COUNTY. Report by J. C. Applegate. M.D 409 

GLOUCESTER COUNTY, Report by William Brewer, M.D 411 

A Case OF Tetanus, by William Brewer, M.D 414 

A Case of Trichinosis, by George E. Reading, M.D 415 



CONTENTS. 481 

PAGE. 

HUDSON COUNTY, Report by J. A. Exton, M.D 416 

The Artificial Feeding of Infants, by Burdette P. 

Craig, M.D 418 

HUNTERDON COUNTY, Report by G. N. Best, M.D 424 

MERCER COUNTY, Report by George N. J. Sommer, M.D 426 

Report of the Proceedings of the District Medical 
Society of the County of Mercer, at Their Fifti- 
eth Anniversary, by G. N. J. Sommer, M.D 430 

History of the District Medical Society of the 
County of Mercer, with Short Sketches of Some 

OF THE Past Members, by Cornelius Shepperd. M.D 433 

MIDDLESEX COUNTY. Report by A. L. Smith. M.D.......... 468 

MONMOUTH COUNTY, Report by E. W. Crater, M.D 470 

SALEM COUNTY. Report by H. T. Johnson. M.D 471 

SOMERSET COUNTY, Report by A. L. Stillwell, M.D 473 

SUSSEX COUNTY, Report by Sidney B. Straley. M.D 473 

UNION COUNTY, Report by R. B. Whitehead. M.D 474 

WARREN COUNTY, Report by J. H. Griffith, M.D 474 

Effects op Pressure on thk Heart's Action, by J. C. 

Johnson, M.D 475 



The Medical Society of New Jersey does not hold 
itself responsible for the sentiments expressed by the 
authors of papers; nor for the reports of clinical cases 
furnished by the reporters of the District Societies. — 
Transactions i8j6, page j8.